LABORATORY SELF INSPECTION FORM


Department:____________________________ Building/Room #: _____________________
Department Safety Officer: ________________ Inspector: ____________________________
Lab Supervisor: _________________________ Inspection Date: _______________________
Chairman: ___________________________ Re-inspection Due: ____________________

S = Satisfactory; U = Unsatisfactory

Item

S

U

Comments

Corrective Action Taken

1. Entrances, exits, hallways, stairways

       

2. Showers/eye wash operative

       

3. Personal protective equipment

       

4. Fire extinguishers/inspection & location

       

5. Pressurized cylinders: storage/usage label

       

6. Room use identification/labeling

       

7. UL Electrical equipment & cords

       

8. Fume hood operation

       

9. Biological safety cabinets

       
  • Certification
       
  • Use
       

10. Hazardous Chemicals

       
  • Labeling
       
  • Storage/amount/location
       
  • Handling
       

11. Hazardous Waste Disposal

       
  • Training certificate
       
  • Labeling
       
  • Storage
       
  • Disposal
       

12. Equipment and utility labeling

       

13. Location of cut-off valves/circuit breakers

       

14. General safety (dress, smoking, etc.)

       

15. Use of flame and heat

       

16. Ventilation

       

17. Housekeeping/drains flushed

       

18. Sharps (glass, scalpel, blades, etc.)

       

19. Emergency lighting

       

20. Emergency plan/posted numbers

       

21. Safety manuals

       

22. Accidents reported/investigated

       

23. Safety Training: Date ___________

       
  • Subject ______________________
       

Laboratory Safety