| Department:____________________________ | Building/Room #: _____________________ |
| Department Safety Officer: ________________ | Inspector: ____________________________ |
| Lab Supervisor: _________________________ | Inspection Date: _______________________ |
| Chairman: ___________________________ | Re-inspection Due: ____________________ |
S = Satisfactory; U = Unsatisfactory
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Item
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S
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U
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Comments
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Corrective Action Taken
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1. Entrances, exits, hallways, stairways |
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2. Showers/eye wash operative |
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3. Personal protective equipment |
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4. Fire extinguishers/inspection & location |
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5. Pressurized cylinders: storage/usage label |
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6. Room use identification/labeling |
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7. UL Electrical equipment & cords |
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8. Fume hood operation |
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9. Biological safety cabinets |
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10. Hazardous Chemicals |
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11. Hazardous Waste Disposal |
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12. Equipment and utility labeling |
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13. Location of cut-off valves/circuit breakers |
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14. General safety (dress, smoking, etc.) |
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15. Use of flame and heat |
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16. Ventilation |
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17. Housekeeping/drains flushed |
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18. Sharps (glass, scalpel, blades, etc.) |
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19. Emergency lighting |
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20. Emergency plan/posted numbers |
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21. Safety manuals |
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22. Accidents reported/investigated |
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23. Safety Training: Date ___________ |
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