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Chemical Hygiene Self Evaluation Form

Instructions: This evaluation form will assist lab workers in identifying common safety problems. If your answer to a question is bold, there may be a safety problem . Refer to the page number listed in the chart or email ehrs@ehrs.upenn.edu for guidance.

Hours of operation

Question Answers Reference
Do staff work after 10:00 PM?   Yes No   Email
Do staff work weekends and holidays? Yes No 11
Do personnel work alone? Yes No 11
Is there a notification procedure for
individuals who work alone?		 Yes No Email

Signs and Documentation

Question   Answers   Reference
Room sign present?   Yes No   22
Work plan posted? (see Appendix E for a copy) Yes No 4

Emergency Equipment

Question   Answers   Reference
Fire Extinguisher Present in lab?   Yes No   Email
Eyewash present in lab? Yes No Email
Shower present in lab OR within 25 feet? Yes No Email
Shower inspected within last year ? Yes No Email

Employee Hygiene

Question   Answers   Reference
Eye or face protection in use?   Yes No   13
Lab coats worn? Yes No 14
Appropriate clothing (long pants, no shorts etc.) worn under lab coats? Yes No 14
Food or drink present in the lab? Yes No 11

Chemical Storage

Question   Answers   Reference
Flammable liquids
(See SOP: Flammable Liquids)
> 10 gallons of flammable liquids stored outside of a flammable liquids storage cabinet? Yes No 17
Total quantity of flammables in lab > 25 gallons Yes No 16
NFPA approved flammable liquids storage cabinet present with vent ports open? Yes No 17
Are only flammable liquids stored in the cabinet (skip if a flammable liquids storage cabinet is not available)? Yes No 16
Corrosive materials
(See SOP: Corrosive Materials)
Segregated from non-corrosives? Yes No 55
Acids stored on plastic trays? Yes No 55
Damage to cabinets (rust, charring)? Yes No Email
Chemical reactions occurring (discolored reagents, white haze on bottles)? Yes No Email
Labels damaged or not present? Yes No Email
Compressed Gases
(See SOP: Compressed Gases)
Cylinders secured so they can't fall? Yes No 53
Lecture bottles stored with regulators in place? Yes No Email
More than 10 lecture spheres stored? Yes No Email
Reactives (solids and liquids)
(See SOPs: Reactive Solids and Reactive Liquids)
Dated? Yes No 71, 83
Stored in original containers? Yes No Email
Evidence of container damage or corrosion? Yes No Email
Segregated from other storage? Yes No Email
Old containers (>2 years)? Yes No Email
Acutely Toxic Chemicals, Reproductive Hazards, Carcinogens
(See SOPs: Acutely Toxic Chemicals, Reproductive Hazards and Carcinogens)
Are the chemicals stored in designated area Yes No 15
Are the chemicals handled in designated area? Yes No 11
Do you have old containers (>5 years)? Yes No Email
Evidence of container damage or corrosion? Yes No Email
General Chemical Storage
(See Section VI: Chemical Storage and Transportation)
Containers dated? Yes No 16
Overstocking evident (multiple containers of a single reagent is present)? Yes No 16
Storage shelves and cabinets secured (Will not tip over)? Yes No 16
Insufficient storage space (are containers stacked on top of each other)? Yes No 16
Solids and liquids segregated? Yes No 16
Chemical reactions occurring (discolored reagents, white haze on bottles)? Yes No 16
Refrigerators/Freezers
(See Section VI: Chemical Storage and Transportation)
Labeled "No food or flammable storage?" Yes No Email
Flammable liquids stored in refrigerator? Yes No Email

Waste Disposal

Question   Answers   Reference
Waste containers properly marked concerning contents?   Yes No   Email
Orphaned chemicals present? Yes No Email
Unknown or unlabeled chemicals stored? Yes No Email

Special Ventilationa

Question   Answers   Reference
Glove box vented?   Yes No   Email
Biosafety cabinet certified within last year? Yes No Email

If any of the following chemicals or pieces of equipment are used in the lab you may have special training or safety requirements. Contact Environmental Health & Radiation Safety for additional instructions.

Question   Answers   Reference
Formaldehyde--Special training required   Yes No   127
Perchloric acid-- Used in hood Yes No Email
Ethylene oxide--Special hazard, contact EHRS Yes No Email
Picric acid--Older than 5 years Yes No 18 - 19
Ethyl ether--Opened more than 6 months ago or not dated Yes No 17 - 18
Phosgene--Special hazard, contact EHRS Yes No Email
Hydride gases--Special hazard, contact EHRS Yes No Email
Benzene--Special hazard, contact EHRS Yes No Email
Ethidium bromide wasteautoclaved Yes No Email