EHRS: Chemical Hygiene Plan

Instructions

Each laboratory has a room sign that provides safety information to visitors and housekeeping personnel (see figure on reverse side). The principal investigator is responsible for assuring that appropriate warning information is included on this sign.
Click here for an example of a room sign.

The sign is composed of four sections. *Section one contains the building name, room number and department name. Please list the department name, building name and room number exactly as you wish it to appear below:

*Section two includes the names of the researchers in the laboratory. Please type in the names below.

Section three provides warning information to visitors and housekeeping personnel. Special labels are available that are placed into the boxes of this section. The labels contain icons alerting the reader that special conditions exist inside the laboratory. Check all that apply:

	CAUTION-BIOHAZARD
	CAUTION-DESIGNATED AREA WITHIN, (Carcinogens, Reproductive Hazards, Acutely Toxic Chemicals Used Within Areas of the Lab)
	CAUTION-DESIGNATED AREA LABORATORY (Carcinogens, Reproductive Hazards, Acutely Toxic Chemicals Used Throughout the Lab)
	CAUTION-RADIOACTIVE MATERIALS Licensee Name (required for Caution-Radioactive Materials sign)
	CAUTION-LASER (Class )
	CAUTION-MAGNETIC FIELD
	CAUTION-STRONG MAGNETIC FIELD (No Metal Permitted)

Section four provides safety department phone numbers. Provide name and evening contact number.

Evening Contact

*Name:
Home Number:
Mobile Number:

Submitted by

*First Name:
*Last Name:
*Email Address:
*School/department:
*Building Name:
*Room/mail code:

* Required Fields

This form is also available in PDF Format.