Building:___________ Room #:_____________ Inspection Date:_______________

Performed By:__________________________________________________________
 
 

I. Regulatory Compliance
 
 

A. MSDS file available Yes___ No___ Comments:

B. Chemical Hygiene Plan available Yes___ No___ Comments:

C. Sign on doors Yes___ No___ Comments:
 
 

II. Safety Equipment
 
 

A. Fire extinguisher Yes___ No___ Comments:

B. Eyewash Yes___ No___ Comments

C. Safety shower Yes___ No___ Comments

D. Emergency numbers on or near phone Yes___ No___ Comments
 
 

III. Chemical Storage
 
 

A. Flammable Storage Cabinet in use Yes___ No___ Comments

B. Corrosives suitably contained Yes___ No___ Comments

C. Chemical storage in hood Yes___ No___ Comments
 
 

IV. Chemical Usage
 
 

A. Labels on self-created containers Yes___ No___ Comments

B. Personal protective equipment in use Yes___ No___ Comments

C. Hood in good operating condition Yes___ No___ Comments D. Appropriate waste receptacles Yes___ No___ Comments

E. Generally good housekeeping Yes___ No___ Comments
 
 

V. Special Problems
 
 

A. Gas cylinders properly restrained Yes___ No___ Comments

B. Water-reactives properly stored/labeled Yes___ No___ Comments

C. Carcinogen working area labeled Yes___ No___ Comments

D. Radioactive material working area labeled Yes___ No___ Comments

E. Biohazard materials labeled Yes___ No___ Comments
 
 

VI. Accidents or incidents since last inspections?
 
 

VII. Other notes and comments: