Date:

1. Chemical Substance Audited:__________________________________________
 
 

2. Work Area Audited:__________________________________________________
 
 

3. Audit Performed By:_________________________________________________
 
 

4. Reason for Audit:

Routine

5. Date Audit Performed: ________________ 6. Time of Audit: _____ a.m. _____ p.m.
 
 

7. Items Audited and Findings:

ITEM                                                          FINDING                           RECOMMENDATIONS

Engineering controls maintained

Labels appropriate

Emergency procedures known

Personal protective equipment used

Workplace monitoring performed

Employees told of monitoring results

Required medical tests performed

Employee concerns, if any

Supervisory concerns, if any

___________________________

___________________________

8. Other Comments:
 
 
 
 

9. Auditor’s Signature:                                                             Date:

10. Route a copy to: 1 - Principal Investigator, 2 - Chemical Hygiene Officer