Inspectors: __________________________________
______________________________________________
______________________________________________

Unit: _______________
Room: _______________
Date: _______________

 1. ___ Building Services
 2. ___ Ventilation/Chemical Fume Hoods
 3. ___ Lighting
 4. ___ Electrical/Fans
 5. ___ Noise
 6. ___ Equipment & Tools
 7. ___ Other

 8. ___ Biological Hazard Storage
 9. ___ Chemical Storage
10. ___ Radiation Storage
11. ___ Hazardous Waste Storage
12. ___ Compressed Gas Cylinder Storage
13. ___ Glassware Storage
14. ___ Pesticide Storage
15. ___ Refrigerators and Freezers
16. ___ General Housekeeping
17. ___ Stools/Ladders
18. ___ Other

19. ___ Emergency Eye Wash Station
20. ___ Emergency Showers
21. ___ Emergency Procedures/Exit
22. ___ Doors/Windows
23. ___ Fire Extinguishers
24. ___ Fire/Smoke/Heat Alarms
25. ___ Emergency Lights
26. ___ Safety Receptacles
27. ___ Warning Signs and Notices
28. ___ First Aid Kits and Medical
29. ___ Facility Plan & Safety Programs/ Material Safety Data Sheets
30. ___ Other

31. ___ Written Programs/Employee Training
32. ___ Personal Protective Equipment
33. ___ Emergency Procedures
34. ___ Hazardous Waste Containers
35. ___ Storage Compatibility
36. ___ Other

2. Ventilation/Chemical Fume Hoods:
   - Machines used with toxic chemicals ventilated?
   - Local exhaust provided where necessary?
   - Hood face velocity certified annually?
   - Fume hood sash operating properly?
   - Is equipment labeled for actual and/or potential hazards present?
   - Is adequate ventilation available in areas where hazardous chemicals are used?
   - Are hoods certified annually/inspected monthly?
   - Are hood sashes operated at their recommended level? Left on permanently?
   - Does hood pull 80 to 100 cfm at 12 inches?
   - Is hood air flow obstructed by equipment?
   - Is hood being used for chemical storage?

3. Lighting:
   - Are stairways/rooms/doorways/etc. well lit?
   - Are light fixtures guarded in areas of moving machinery, ladders, pipes, etc.?
   - Are exterior/greenhouse lights/receptacles/conduit/etc. waterproof and/or dust-proof?

4. Electrical/Fans:
   - Are panels clear, un-blocked & labeled?
   - Are face plates and knockout plugs intact?
   - Electric cords, phones lines, etc. secured under desks or along baseboard? Knotted?
   - No permanent extension cords?
   - Electrical or extension cords worn/frayed?
   - Are fans and related electrical equipment properly grounded or double insulated?
   - Well guarded?
   - Outlets overloaded? Three-prong plugs?

6. Equipment & Tools:
   - Are all machines that expose operators to rotating parts, pinch points, flying chips, particles or sparks adequately guarded?
   - Are emergency cutoffs at point of operation?
   - Are all point of operation guards in place?
   - Training and documentation?

7. Other:
   - Grinding room free of excessive dust?

8. Biological Hazard Storage:
   - Access limited or restricted?
   - Are warning signs posted?
   - Wastes stored in leak-proof containers?
   - Are biological safety cabinets or other physical containment devices available?
   - Are surfaces clear & easy to clean?
   - Are waste containers orange & labeled?
   - Sharps stored in puncture-resistant containers

9. Chemical Storage:
   - Flammables put away when not in use?
   - Are acids/toxins/flammables in safety cabinets?
   - Are cabinets properly ventilated?
   - Cabinets adequate for activity & hazard levels?
   - Contents labeled, inventoried and recorded?
   - Stored by compatibility types?
   - Minimal amounts stored in laboratories?
   - Are shelf-lives & records maintained?
   - Are secondary containment trays used?
   - Are spill kits and neutralizers available?
   - Self-venting squirt bottles used with ethanol, acetone?

11. Hazardous Waste Storage:
   - Are safety cabinets & cans used?
   - Are waste containers of sufficient strength to resist ripping, tearing, leaking or bursting? Are containers labeled properly?
   - Free of damage, leaks & spills?
   - Properly closed when not immediate use?
   - Incompatibles properly separated?

12. Compressed Gas Cylinders:
   - Are cylinders securely strapped or chained?
   - Are cylinders not in use capped?
   - Cylinders stored upright? Nothing on top?
   - Cylinder program & training provided?
   - Stored away from ignition sources?
   - Oxygen cylinders away from combustibles?
   - Cylinders marked Full/In Use/Empty?
   - Cylinder contents labeled?

13. Glassware Storage:
   - Glass inspected & damaged glass disposed of or repaired?
   - No heavy, breakables stored on top of lockers, cabinets, window sills, etc.?
   - No storage on top of light fixture and pipes?

15. Refrigerators & Freezers:
   - Are proper types used? Properly labeled?
   - Flammable or explosion-proof design?
   - Setting adequate to prevent spoilage?
   - Defrosted and clean? No food nor drink?
   - Walk-ins open from inside? When locked?
   - Spark-proof electrical equipment?
   - Chemicals/toxins/gases stored inside?

16. General Housekeeping:
   - Coffee pots, dishes, etc. not in lab area?
   - Floor mats smooth & properly used?
   - Materials stored so will not fall?
   - No eating/drinking in lab?
   - Are floor surfaces clean/dry/level/nonslip?

17. Stools & Ladders:
   - Are step stools and ladders available for obtaining items from high places?
   - In proper condition with no broken steps?
   - Forklift use & training provided?

18. Other:
   - Liquid nitrogen stored in ventilated areas?
   - Explosion blow-out panels in place?
   - Flammable dispensing nozzles/containers properly grounded and bonded?

20. Emergency Showers:
   - Station clear, un-blocked & labeled?
   - Station within 100 feet of hazard?
   - Is station easy to find?
   - Is station tested periodically?

21. Emergency Procedures/Exits:
   - Exits clear & un-blocked?
   - Are non-exits labeled "No Exit"?
   - Do doors open in direction of egress?
   - Are all emergency exits unlocked?
   - Are evacuation procedures posted?
   - Are plans developed, employees trained and drills conducted?
   - Are handicapped procedures in place?

22. Doors & Windows:
   - Are doors and aisles clear?
   - Are doors blocked opened?
   - Are doors routinely closed?
   - Do fire doors automatically close or normally kept closed?
   - Are fire doors undamaged & operational?
   - Are windows routinely closed?

23. Fire Extinguishers:
   - Extinguishers clear & un-blocked?
   - Readily available with proper signage?
   - Checked monthly (pull-ring seal/pressure / damaged/blocked/tagged/initialed/etc.)?
   - Annually tested with 5 year hydrostatic test?
   - Extinguishers painted red & well labeled?
   - Sufficient number & proper type (ABC)?
   - Employees trained to use them?

24. Fire/Smoke/Heat Alarms:
   - Are fire/smoke/heat sensors installed?
   - Are fire alarms audible?     Audible?
   - Are they checked periodically?
   - Do you know location of detectors & stations?
   - Are pulls boxes in normal path of exit?
   - Are pulls boxes well labeled & marked?

26. Safety Receptacles:
   - Broken glass sharps receptacles available?
   - Biohazard material receptacles available?

27. Warning Signs & Notices:
   - Warning signs which designate hazards?
   - Are rooms labeled with unit, occupant(s) and emergency notification numbers?
   - Are rooms labeled for hazard(s)?
   - Have ancillary staff received warning identification training?

28. First Aid & Medical:
   - Appropriate  supply of first aid kits and equipment available?
   - Kit contents sanitary & well stocked?
   - System for medical treatment provided with employee training (call 911)?
   - First aid & CPR trained personnel?
   - Emergency phone number posted?

29. Facility & Safety Programs Material/
   Safety Data Sheets:
   - MSDS file available and/or posted?
   - Safety reference materials available (Chemical Inventory, UW Safety & Disposal Guide, CHP)?
   - Employees familiar with them?
   - Facility Self-Protection Plan available and employee training provided?
   - Safety Manuals and Programs available and employee training provided?
   - Accident and reporting procedures in place and employee training provided?

30. Other:
   - "No Smoking" Policy enforced?

32. Personal Protective Equipment:
   - Is proper eye wear utilized?
   - Is proper protective clothing available?
   - Do only trained personnel work in the lab?
   - Are gloves removed prior to exiting lab?
   - Is exposure monitoring performed where required (radio isotopes)?

33. Emergency procedures:
   - Is emergency information posted in accumulation areas (evacuation route, emergency number, procedures, etc.)?
   - Are emergency materials & supplies available (fire extinguishers/sorbents/spill kits and supplies/MSDSs/etc)?
   - Are there programs for contingency plans, emergency procedures and preparedness and prevention in place?
   - Is the fire department familiar with the facility location & specific hazards?
   - Are aisles and emergency exits clear and un-blocked? Marked well?

34. Hazardous Waste Containers:
   - Are records maintained?
   - Closed when not adding or removing waste?
   - In secondary containment or use of plastic carboys?
   - Are approved containers and cabinets used for storage and handling of flammables?

36. Other:
   - Are there any unmarked containers or seemingly abandoned containers?
   - Is there evidence that chemicals are disposed in methods other than those approved by UW policy?