QUARTERLY LABORATORY INSPECTION FORM

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1 Instructions: Checklist items should be answered Yes, No, or Not applicable. For every item answered No, provide the Corrective Action. Once corrected, provide the date the correction is completed. Items not listed in this report may be included under Miscellaneous: Other Items on the last page of the form. Distribution: On completion of the inspection, the original inspection report should be retained by the department and a copy provided to the Departmental Safety Representative (DSR) in charge of the area. The DSR will forward a copy to the Office of Environmental Health & Safety via campus mail (TW-16) or fax Inspection Conducted By (PRINT): Date of Inspection: Campus: Building and Room #s: Dept: Telephone Number: address: Signature of Inspector: Note: Please remember that inspection reports are to be submitted QUARTERLY to the DSR in charge of the area. The DSR will forward the report to the Office of Environmental Health & Safety.

2 1 HO ODS/VENTILATION WORKING/HOODS CERTIFIED WITHIN 1 YEAR (There is sufficient draft across face of hood fpm average face velocity. To schedule certification, contact Pam Fatland of OEHS (504) ) 2 HOOD SASH WORKING PROPERLY (Sash is not stuck, glass is not broken or etched; no repairs to sash or pulley system needed) 3 PANELS/AIRFOILS ARE IN PLACE ON HOOD (Side or back panels or front airfoil are in place and are not missing or broken; hood has smooth surfaces for low turbulence) 4 VANEOMETER OR ALARM MOUNTED PROPERLY, WORKING (Vaneometer/alarm in hood is mounted and working properly, hood is not in alarm, alarm seems properly calibrated) 5 CHEMICALS/EQUIPMENT ARE USED AT LEAST 6 INCHES INSIDE HOOD 6 LARGE EQUIPMENT IS NOT STORED IN FRONT OF HOOD/ EXHAUST VENT 7 LOOSE PAPER TOWELS NOT LEFT IN HOOD (Can be sucked into ductwork and damage exhaust fans) 8 HOOD USED FOR EXPERIMENTS NOT FOR CHEMICAL OR EQUIPMENT STORAGE (Exhaust ventilation should not be obstructed with excess chemical containers or large pieces of equipment) 9 FILTERS ON COUNTERTOP VENTILATION UNITS ARE REPLACED PERIODICALLY AS PER MANUFACTURER S RECOMMENDATIONS (Filter change date okay) 10 VENTILATION ADEQUATE/ADDITIONAL VENTILATION NOT NEEDED (No odors or ventilation concerns noted) HOODS AND VENTILATION

3 11 BIOS AFETY CABINETS HAVE BEEN CERTIFIED WITHIN 1 YEAR (To schedule, contact Kim Chapital of OEHS (504) ) 12 BUNSEN BURNER NOT USED IN BIOL. SAFETY CABINET (Use of gas in a biological safety cabinet can pose a potential fire or explosion hazard, can interfere with airflow patterns, and the heat produced by the Bunsen burner can damage the HEPA filter and/or the filter s adhesive. Instead OEHS recommends electric burners and micro-incinerators be used in the rear of the workspace.) 13 FIRE EXTINGUISHER/FIRE EQUIPMENT IS ACCESSIBLE (not obstructed) 14 FIRE EXTINGUISHER IS MOUNTED AND LOCATED NEAR THE EXIT OR NEARBY IN HALLWAY 15 FIRE EXTINGUISHER HAS BEEN INSPECTED WITHIN LAST MONTH 16 THERE IS NO STORAGE LOCATED WITHIN 18 INCHES OF A SPRINKLER HEAD 17 EMERGENCY LIGHTS/STROBES ARE NOT OBSTRUCTED 18 EXITS ARE NOT OBSTRUCTED AND ARE PROPERLY MARKED BIOLOGICAL SAFETY CABINETS FIRE ALARMS/EXTINGUISHERS/EQUIPMENT EYEWASHES/DRENCH HOSES/SHOWERS 19 A PLUMBED EYEWASH STATION IS AVAILABLE (OEHS does not recommend plastic eyewash bottles containing saline. Eyewash is required in areas where corrosives or irritants are used.)

4 20 EYEWASH/DRENCH HOSE/SHOWER IS EASILY ACCESSIBLE (Not obstructed) 21 EYEWASH/DRENCH HOSE IS WORKING PROPERLY (No adjustments needed, water pressure adequate) 22 SHOWER HANDLE IS IN PLACE (Not missing, does not need repair, cover plate at ceiling not coming off) 23 EYEWASH HAS PROTECTIVE CAPS IN PLACE OVER NOZZLES (Keeps nozzles from becoming dirty and clogged) 24 EYEWASH IS NOT DRIPPING/LEAKING/NOT DRAINING (Plumbing repairs are not needed) 25 DOOR/HAZARD/ROOM SIGN IS UP-TO- (No changes needed, appropriate hazard and emergency information is listed) 26 EYEWASH/REFRIGERATOR/EQUIPMENT LABELS ARE IN PLACE (No additional biohazard, radiation, etc. labels needed for equipment) 27 SIGNAGE IS MOUNTED PROPERLY (Not coming off, easily visible, not obstructed) 28 FLAMMABLES ARE NOT STORED IN IMPROPER REFRIGERATOR/FREEZER/COLD ROOM (Flammables cannot be stored in refrigerator/freezer/cold room which is not designed for flammable storage must be explosion proof or flammable liquid storage refrigerator/freezer) 29 REFRIGERATOR/FREEZER/COLD ROOM IS CLEAN & IN GOOD CONDITION (Does not need defrosting or cleaning) 30 FOOD/BEVERAGES ARE NOT PRESENT IN LAB REFRIGERATOR/FREEZER/COLD ROOM SIGNAGE REFRIGERATORS/FREEZERS

5 31 GASKET IN GOOD CONDITION (Does not need replacement or cleaning) 32 THERE IS NO EVIDENCE OF EATING/DRINKING/SMOKING IN LAB 33 APPROPRIATE LAB ATTIRE IS WORN IN LAB (No shorts/sandals/flip-flops, etc.) 34 ALL SHARPS ARE SECURED (No razor blades or needles left on counters) 35 PROPER BIOHAZARD WASTE AND SHARPS CONTAINERS ARE USED (Appropriate red bags, boxes, puncture proof sharps containers available) 36 SHARPS BOX IS UPRIGHT WITH COVER IN PLACE (Not on side, sharps cannot spill out) 37 GLASS BOX/BIOHAZARD/SHARPS BOX IS DISPOSED WHEN NEEDED (Not overflowing, no greater than two-thirds full) 38 BROKEN GLASS/GLASSWARE DISCARDED PROPERLY (Glassware in lab in good condition, broken glass/glassware discarded properly) 39 BIOHAZARD WASTE KEPT COVERED (No open containers of biohazard waste in lab) 40 GAS CYLINDERS SECURED PROPERLY (Upright, tightly secured with proper chain, strap, or cylinder stand on top third of cylinder) EATING/DRINKING/SMOKING/ATTIRE BIOHAZARDS/SHARPS CHEMICAL STORAGE

6 41 GAS CYLINDERS HAVE CAPS IN PLACE (Unless in use and attached to a regulator) 42 FLAMMABLE CABINET IS LATCHED AND CLOSES PROPERLY (No repairs needed) 43 FLAMMABLE CABINET/REFRIG/SHELVING ARE ACCESSIBLE AND STEADY (No rocking, access not blocked by equipment) 44 LESS THAN 10 GALLONS OF FLAMMABLE LIQUIDS ARE STORED IN GLASS CONTAINERS OUTSIDE OF A FLAMMABLE LIQUID STORAGE CABINET 45 CHEMICALS ARE NOT STORED ON FLOOR (Unless secondary containment is used) 46 INCOMPATIBLE CHEMICALS ARE STORED SEPARATELY (Acids separate from bases, oxidizers separate from flammables) 47 CHEMICAL CONTAINERS ARE IN GOOD CONDITION (Cans not corroding, caps not leaking, containers not cracked) 48 CONTAINERS OF CHEMICALS ARE OF 1 GALLON SIZE OR SMALLER, EXCEPT IF STORED IN SAFETY CANS (2 GAL MAXIMUM SIZE SAFETY CANS FOR LABS) 49 ETHER & PEROXIDE-FORMING CHEMICAL D AND USED WITHIN SIX MONTHS (Or peroxide testing is performed) 50 ALL CONTAINERS ARE PROPERLY LABELED (Full chemical name & associated hazards, no symbols or abbreviations) 51 ALL CONTAINERS ARE CAPPED UNLESS ACTIVELY POURING (No open containers, no containers with funnels left in hood)

7 52 CHEMICALS/GLASSWARE STORED PROPERLY (Not on edge of shelf, under lock & key if required, large containers of acids on lower shelves, etc.) 53 CHEMICALS DISPOSED PROPERLY (There is no large accumulation of hazardous waste in lab; hazardous wastes are properly contained, stored, labeled and proper disposal procedures are followed) 54 HIGHLY TOXIC MATERIALS, CARCINOGENS, ETC. ARE KEPT IN CLOSED CONTAINERS AND USED WITH ADEQUATE VENTILATION IN MARKED, DESIGNATED AREAS 55 A CHEMICAL INVENTORY IS SUBMITTED TO OEHS AT LEAST ANNUALLY FOR THIS LAB 56 EMPLOYEES IN LAB ARE TRAINED IN THE PROPER HANDLING OF HAZARDOUS MATERIALS AND WASTES 57 AN UP-TO- CHEMICAL HYGIENE PLAN AND STANDARD OPERATING PROCEDURES ARE AVAILABLE FOR THIS LAB (Must be submitted to OEHS at least annually) 58 ELECTRICAL EQUIPMENT AND CORDS ARE IN GOOD CONDITION (Do not need repair or discard, no frayed wires, etc.) 59 EQUIPMENT GUARDED PROPERLY (Protective guards located around belts & pulleys, pinch-points, moving parts, etc.) 60 ELECTRICAL OUTLET/LIGHT SWITCH COVERS IN GOOD CONDITION (Not cracked or broken) 61 ELECTRICAL PANELS ARE NOT OBSTRUCTED (Fire codes require 3-foot clearance around electrical panels) EQUIPMENT/ELECTRICAL

8 62 ADEQUAT NUMBER OF GROUNDED ELECTRIAL RECEPTACLES ARE PROVIDED/EQUIPMENT IS PLUGGED IN PROPERLY (No cheater plugs used, proper outlet for threeprong electrical equipment, etc.) 63 MULTI-OUTLET STRIPS USED ONLY FOR COMPUTER CONFIGURATIONS (Not to be used for other lab equipment) 64 EXTENSION CORDS ONLY USED FOR TEMPORARY PURPOSES (Not being used for permanent fixed wiring. If additional outlets are needed, contact Facilities Services) 65 ELECTRICAL CORDS ARE NOT RUN THROUGH DOORWAYS/WALLS/CEILINGS 66 EQUIPMENT IS STORED PROPERLY (Not falling off shelves or stored in aisles) 67 LIGHTS/EXIT SIGNS/EMERG LIGHTS WORKING PROPERLY (None are burned out) 68 THERE IS NO SPACE HEATER LOCATED IN LAB 69 HEAT PRODUCING EQUIPMENT IS USED PROPERLY (Not left on and unattended, or used near flammable liquids) 70 HOUSEKEEPING IN LAB GOOD (Counters & aisles not cluttered, no spills/leaking materials, no trash strewn about, etc.) 71 PAPER PADS IN GOOD CONDITION (Not dirty or in need of replacement) 72 COMBUSTIBLES (boxes, cardboard, etc.) NOT STORED IN LAB HOUSEKEEPING AND RELATED HAZARDS

9 73 NO EVIDENCE OF MOLD GROWTH; CEILING TILES NOT STAINED OR MISSING; NO WATER STAINS ON WALLS OR FLOORS 74 NO EVIDENCE OF PEELING PAINT/RUST/STAINS 75 AISLES & EXITS ARE MAINTAINED (Not obstructed) 76 NO SLIP/TRIP HAZARDS OBSERVED (No cords across aisles, no broken floor tiles, etc.) 77 DOORS ARE LATCHING PROPERLY/STAIRWELL DOORS ARE NOT PROPPED OPEN 78 NO HOLES IN WALLS/CEILINGS (Contact Facilities Services for repairs) 79 NO HALL OR STAIRWELL STORAGE 80 NO TRASH OVERFLOWING 81 NO EVIDENCE OF A SPILLED OR LEAKING CHEMICAL 82 TUBING FOR BUNSEN BURNER/GAS USE IS IN GOOD CONDITION 83 LAMINATE ON COUNTERS IS IN GOOD CONDITION 84 CABINET DOORS ARE CLOSING PROPERLY 85 PPE IS STORED PROPERLY (Goggles not hanging by straps, respirators stored in plastic bag, etc.) 86 USED PPE DISPOSED PROPERLY (No dirty gloves left on counter, etc.) PERSONAL PROTECTIVE EQUIPMENT (PPE)

10 87 PPE USED WHEN NEEDED (Goggles worn when pouring chemicals, facesheilds and proper gloves used with cryogenics, etc.) 88 PPE AVAILABLE AND IN GOOD CONDITION (Gloves not torn, eyewear not scratched or dirty, etc.) 89 EMPLOYEES ARE TRAINED IN PROPER USE OF PPE AND ARE FAMILIAR WITH ANY LIMITATIONS 90 FAUCET/ SINK WORKING PROPERY - DOES NOT NEED REPAIR (Doesn t drip, leak, etc.) 91 BICYCLES ARE NOT LOCATED IN LAB OR HALLWAY 92 FURNITURE IS IN GOOD CONDITION AND APPROPRIATE FOR LAB USE (Not broken or in need of repair) 93 OTHER ITEMS: MISCELLANEOUS