Building and Room:
Date and PI:
Persons Present:

Lab Safety Audit Form

General Work Environment
Work areas illuminatedYESNON/A
Storage of flam. materials minimizedYESNON/A
Trash removedYESNON/A
Heavy items on lower shelvesYESNON/A
Stool available for high itemsYESNON/A
No storage within 18 inches of ceilingYESNON/A
Exit signs present and workingYESNON/A
Exits not blockedYESNON/A
Highly toxic materials secureYESNON/A
Emergency Facilities
Fire extinguishers presentYESNON/A
Fire extinguishers charged and inspectedYESNON/A
Fire blankets presentYESNON/A
Fire alarms unobstructedYESNON/A
Satefy showers flushed and workingYESNON/A
All eye wash fountains flushed and workingYESNON/A
Spill kit present and stockedYESNON/A
Information Access
CHP availableYESNON/A
Site-specific SOP availableYESNON/A
MSDS or SDS availableYESNON/A
Door posting safety glassesYESNON/A
Door posting hazardous materialsYESNON/A
Door posting pressureYESNON/A
Door posting no foodYESNON/A
Door posting emergency phone #sYESNON/A
Door posting otherYESNON/A
Personal Protective Equipment
Satefy glasses worn at all timesYESNON/A
Goggles or face shields availableYESNON/A
Proper gloves worn or availableYESNON/A
Lab coats availableYESNON/A
Proper other clothing, hair, jewelryYESNON/A
Electrical Safety
Cords in good shapeYESNON/A
Cover plates installedYESNON/A
Circuit breaker panels unobstructedYESNON/A
Machine covers installedYESNON/A
No exposed electrical conductorsYESNON/A
Ground fault circuit interrupters installedYESNON/A
GFCI workingYESNON/A
Chemical Storage
Shelving adequate for loadsYESNON/A
Proper refrigeration units and labelsYESNON/A
Approved flammable cabinets and labelsYESNON/A
Toxic gases in vented cabinetsYESNON/A
Proper containers with labelsYESNON/A
Fume hood storage minimizedYESNON/A
Incompatible chemicals segregatedYESNON/A
Corrosives stored below eye levelYESNON/A
Storage quantities minimizedYESNON/A
Secondary containment for transportYESNON/A
Chemicals with shelf lives datedYESNON/A
Fume hoods used for hazardous chemicalsYESNON/A
Gases used in well-ventilated areasYESNON/A
Gas cylinders secured with chain or strapYESNON/A
Proper regulator usedYESNON/A
Protective valve covers usedYESNON/A
Cylinder carts used for transportYESNON/A
Empty cylinders returned promptlyYESNON/A
Cryogen containers ventedYESNON/A
Cryogen dewars shieldedYESNON/A
PPE used when dispensing cryogensYESNON/A
Waste containers appropriate and labeledYESNON/A
Separate bins for broken glassYESNON/A
Separate bins for sharpsYESNON/A
Full waste containers removed from labYESNON/A
Training and Awareness Interview
All employees received CHP trainingYESNON/A
All employess have fire extinguisher trainingYESNON/A
What to do in case of fire?YESNON/A
Where is CHP and SDS?YESNON/A
How to treat spill?YESNON/A
PPE use?YESNON/A
Hood use?YESNON/A
What to do with waste?YESNON/A
What is most hazardous chemical used?YESNON/A
How to use eye wash fountain?YESNON/A
What are symptoms of chemical exposure?YESNON/A
Ventilation
Mechanical inspectionYESNON/A
Baffles workingYESNON/A
Baffles unobstructedYESNON/A
Emergency flow buttonYESNON/A
Mute button workingYESNON/A
Flow resultsYESNON/A
Any repairs required?YESNON/A
Hood lockout?YESNON/A
Repairs completed?YESNON/A
Summary of Findings
Any work order repairs needed?YESNON/A
Any behavioral changes needed?YESNON/A
Copy sent to PI or Dean?YESNON/A
OtherYESNON/A