Injury & Illness Prevention Program
Office of Environment, Health & Safety
University of California, Berkeley
2006 LABORATORY SELF-INSPECTION
As part of a Cal/OSHA requirement for an effective Injury and Illness Prevention Program (IIPP) as
well as a requirement by the Federal Environmental Protection Agency (EPA), all campus
workspaces are required to perform and document self-inspections annually. The attached
Laboratory Self-Inspection Form will help document laboratory safety inspections and will assist
laboratory researchers in identifying and correcting many common, unsafe practices and
conditions. The unsafe practices and conditions identified on this form are prohibited by state laws
or campus policies, or are not generally accepted as safe laboratory practices.
The procedures for completing this form are as follows:
1. Designate a qualified1 individual to inspect each laboratory using this form, or an equivalent.
2. Send a photocopy of the completed form to your Department Safety Coordinator (DSC).
3. Share the completed form with the Principal Investigator (PI) and other laboratory users. Discuss
the findings and corrective actions in a laboratory meeting and encourage others to voice their
safety concerns.
4. Correct each identified deficiency as soon as possible and document the correction on the
original form.
5. Keep the original form on file in the laboratory for at least one year, so that it will be available to
Cal/OSHA, granting agencies, or campus research oversight groups, if requested.
6. If you need assistance correcting conditions identified during the self-inspection or have any
questions or concerns about laboratory safety, whether they pertain to this inspection or not,
contact your DSC or the Office of Environment, Health & Safety (642-3073).
This form was designed to help ensure compliance with Cal/OSHA, EPA, and other
regulations. During some recent Cal/OSHA inspections, laboratories that were able to
provide this completed form avoided monetary fines. However, completion of this form
and correction of any findings noted herein does not guarantee that these agencies will
not issue citations.
EH&S plans to spot check many of the returned forms, comparing notations with actual
conditions in the laboratory. Additionally, EH&S will periodically verify that completed
self-inspection forms are being kept on file in the laboratory or department. These actions
are done to ensure that questions are not misinterpreted and this program remains
effective.
1 1Qualified: The Principal Investigator (PI), laboratory manager, or a person designated by the PI, who by reason of
training, experience, or instruction has demonstrated the ability to identify potential hazards.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
Please note:
This form does not address specific activities involving research animals, biohazardous agents,
lasers, radioactive materials or radiation-producing machines, which have separate and unique
inspection requirements that are part of their approval process.
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
University of California, Berkeley
2006 Laboratory Self-Inspection Form
Please print.
Department: _____________________________________ Date of Inspection: _______________________________
PI Name:
_____________________________________ Inspector Name: ________________________________
Room and Bldg.: _________________________________
Inspector E-mail: ________________________________
Please check the boxes indicating Yes (satisfactory), No (needs correction), or N/A (not applicable).
GENERAL HAZARDS
1. Are aisles, exits, and adjoining hallways maintained free of obstructions
that would hinder emergency access or exiting?
1  Yes  No  N/A
Corrective Action: Remove obstructions from aisles, exits, and adjoining
hallways. Contact Department Safety Coordinator if help is needed clearing
adjoining hallways.
Completion Date: ———————————————————
2. Are there at least 18 inches (47 cm) of vertical clearance between all
stored items and the ceiling-mounted fire sprinklers? (If there are no
sprinklers, measure to the ceiling itself.)
2  Yes  No  N/A
Corrective Action: Remove stored items that could block sprinklers or
contribute to spreading fire to the ceiling.
Completion Date: ———————————————————
3. Are approved sharps waste containers available for disposal of needles,
blades, and other sharps? (Reminder: There should be a proper
procedure for disposal of broken glass.)
3  Yes  No  N/A
Corrective Action: Purchase a sharps container, if needed. Train all laboratory
personnel to avoid bending, cutting, or re-capping syringe needles. The EH&S
Fact Sheet “Handling and Disposing of Sharps” is available at
www.ehs.berkeley.edu. (Do not put broken glass in the general laboratory trash;
put it in a separate and properly labeled container that can be safely disposed
of.)
Completion Date: ———————————————————
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
EMERGENCY EQUIPMENT
4. Are all emergency eyewash and shower stations free of obstructions that
would prevent quick access by someone temporarily blinded by a
chemical splash?
4  Yes  No  N/A
Corrective Action: Remove all obstructions from emergency eyewashes and
showers.
Completion Date: ———————————————————
5. Are the emergency eyewashes for the laboratory tested (flushed)
monthly and are the tests documented?
5  Yes  No  N/A
Corrective Action: Verify that eyewashes that would be used in an emergency
are being flushed monthly, including eyewashes that you rely on but that may
be outside of the laboratory (such as in the hallway). Document each test on an
attached tag. Contact Physical Plant–Campus Services for plumbing repairs or if
safety shower is not being tested annually. Contact EH&S (642-3073) for
eyewash tags or if you have questions on testing of emergency eyewashes or
showers.
Completion Date: ———————————————————
CHEMICAL STORAGE
6. Are chemical fume hoods kept uncluttered so that air flows properly
(e.g., is storage minimized and are adequate work areas provided)? Can
ALL chemical work be done more than six inches into hood? (Note:
Chemical fume hood sashes must be in good condition and be used at
the proper setting.)
6  Yes  No  N/A
Corrective Action: Train laboratory users to minimize hood clutter and place
sashes to maintain good airflow and provide splash protection. Contact Physical
Plant-Campus Services for repairs. The EH&S Fact Sheet “Fume Hoods” is
available at www.ehs.berkeley.edu.
Completion Date: ———————————————————
7. Does the EH&S sticker on the fume hood indicate a hood airflow test
within the last 12 months?
7  Yes  No  N/A
Corrective Action: There should be a red EH&S sticker that indicates the
date EH&S checked the airflow and whether the airflow is satisfactory
(UCB satisfactory range is generally 100-150 feet per minute). If you are
sure the hood is not functioning properly contact your building or
facility manager and ask for a service request to fix the fume hood. For
further information on proper use of fume hoods, call EH&S at 642-3073
or get our fume hood fact sheet at ehs.berkeley.edu (go to publications).
Completion Date: ———————————————————
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
8. Are all chemical containers (including squirt bottles and unwanted
hazardous materials containers) clearly labeled with their contents and
primary hazard(s) and are they in good condition (not corroded or
leaking)?
8  Yes  No  N/A

Corrective Action: Label all chemical containers and replace those that are
corroded or leaking. Chemical containers must be kept closed when not in use.
Completion Date: ———————————————————
9. Are corrosives stored below eye level and are incompatible chemicals
stored appropriately (e.g., acids separate from bases, oxidizers separate
from flammables)?
9  Yes  No  N/A
Corrective Action: Segregate chemicals by hazard class. Contact EH&S (6423073) for assistance with chemical segregation or to obtain a copy of the booklet,
“Safe Storage of Hazardous Chemicals,” or visit the web site
www.ehs.berkeley.edu.
Completion Date: ———————————————————
10. Are containers of hazardous chemicals [1-gallon (4-liters) or larger]
stored in secondary containment to contain a spill?
10  Yes  No  N/A
Corrective Action: Provide secondary containment such as chemically-resistant
tubs or coated bottles. The container should be equal to or greater in size than
the primary container.
Completion Date: ———————————————————
11. Are peroxide formers (such as isopropyl ether and diethyl ether) stored
away from light and heat and labeled with the date they were opened
and the expiration date?
11  Yes  No  N/A
Corrective Action: Label all peroxide formers with opening and expiration
dates. These chemicals may become explosive after prolonged storage. If any of
these chemicals are present and have not been used for a long time, do not
handle. Contact EH&S (642-3073) and ask for potentially-explosive-chemical
assistance, or visit the web site
www.ehs.berkeley.edu/pubs/guidelines/pecguidelines.html.
Completion Date: ———————————————————
LABORATORY EQUIPMENT
12. Look inside each refrigerator and freezer in your laboratory to ensure
flammables are stored in units that are suitable for storage of
flammables. Is each refrigerator and freezer in the laboratory labeled as
either “safe” or “unsafe” for storage of flammables?
12  Yes  No  N/A
Corrective Action: Contact EH&S (642-3073) for assistance in determining if
refrigerators are suitable for storage of flammables. The EH&S Fact Sheet
“Storing Flammable Liquids in Refrigerators and Freezers” is available at
www.ehs.berkeley.edu. Contact EH&S for labels or use an indelible marker.
Completion Date: ———————————————————
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
13. Look inside each refrigerator and freezer in your laboratory to ensure
food is stored only in units designated “food only.” Are all refrigerators,
freezers, and microwave ovens properly labeled either “Food Only” or
“No Food or Drink Allowed?”
13  Yes  No  N/A
Corrective Action: Label all refrigerators and microwave ovens as “Food Only”
or “No Food.” Contact EH&S (642-3073) for labels, or use an indelible marker.
Completion Date: ———————————————————
14. Are all compressed gas cylinders adequately secured with noncombustible restraints to keep the cylinders from falling? (Bench clamps
are not adequate to secure large cylinders. Gas cylinders should be
capped when not in use.)
14  Yes  No  N/A
Corrective Action: Use metal straps or chains. There should be one chain for the
upper half and another for the lower half of large cylinders. Contact your
department shop or Physical Plant-Campus Services for assistance in installing
gas cylinder restraints. In addition, laboratory users should remove the
regulator and cap compressed gas cylinders when not in use and return them to
the supplier if no longer needed.
Completion Date: ———————————————————
HAZARDOUS CHEMICALS
15. Is there a Chemical Hygiene Plan (CHP) in the laboratory that has been
completed or updated within the last 12 months and have all laboratory
personnel reviewed the CHP and documented their understanding by
signing the last page?
15  Yes  No  N/A
Corrective Action: Contact your Department Safety Coordinator or EH&S if you
need a CHP flipchart. Select and assign a Chemical Hygiene Officer for the
laboratory and have him/her read, fill out, and follow the guidance in the
flipchart. EH&S recommends posting the CHP in the laboratory by the
telephone.
Completion Date: ———————————————————
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
16. Ensure the Personal Protective Equipment (PPE) identified in the Standard
Operating Procedures (SOP) page in the yellow Chemical Hygiene Plan is
available to laboratory personnel. Identify additional PPE needs on the right side
of this form.
Corrective Action: Work with your PI or laboratory manager to ensure proper
PPE for the work done in your laboratory is available including: safety glasses,
goggles, face shields, protective gloves (chemical, thermal, etc), laboratory coats,
aprons, and other PPE specific to the work done in your laboratory.
Completion Date: ———————————————————
16  Yes  No  N/A
Additional PPE needed for
this laboratory (quantity)
___safety glasses
___goggles
___face shields
___laser safety eyewear
___laboratory coats
___aprons
___other safety equipment
(specify)
___gloves for:
___chemical hazards
___thermal hazards
___physical hazards
17. Has the laboratory's chemical inventory been completed or updated
within the last year (or within 30 days of a significant change such as a
move to a new location or addition of new chemicals) and submitted to
the EH&S Chemical Inventory database, and has a new, colored,
hazardous materials door sign been posted at the laboratory entrance?
17  Yes  No  N/A
Corrective Action: Update and submit the chemical inventory, and post a new
color version of the hazardous materials door sign. Review the EH&S Chemical
Inventory Fact Sheet at http://www.ehs.berkeley.edu or contact EH&S (6423073) with any questions, or for assistance regarding the Chemical Inventory
Program or the affiliated Hazardous Materials Door Sign Program.
Completion Date: ———————————————————
ELECTRICAL
18. Are extension cords used only as temporary wiring (<30 days) and not
connected in a series (daisy-chained) with other extension cords or
power strips? (Cords must be in good condition with no breaks or
exposed wiring.)
18  Yes  No  N/A
Corrective Action: Dispose of, or repair, all electrical cords that are not in good
condition. Remove all daisy-chained and permanent extension cords. Contact
Physical Plant-Campus Services for installation of additional outlets where
needed.
Completion Date: ———————————————————
19. Is high voltage equipment clearly labeled, properly guarded, and is its
use restricted to trained personnel only?
19  Yes  No  N/A
Corrective Action: Label all high voltage equipment (with voltage >600 volts)
with appropriate warning. Restrict use of this equipment to properly trained
personnel. Retain documentation of the training.
Completion Date: ———————————————————
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
ERGONOMICS
20. Have ergonomic evaluations been done for laboratory employees who
use a computer for four or more hours per day and for those who have
requested an ergonomic evaluation?
20  Yes  No  N/A
Corrective Action: Contact your supervisor or Department Safety Coordinator
to have a trained ergonomic evaluator assess the computer workstations and
document the evaluations. If your department does not have an ergonomic
evaluator, contact University Health Services, Ergonomics@Work program
(642-8410). Also, laboratory ergonomic information (such as microscope use and
pipetting) is available at
http://www.uhs.berkeley.edu/Facstaff/Ergonomics/lab/index.shtml
Completion Date: ———————————————————
REMINDER
It is recommended that furniture and equipment over four feet tall be
bolted to the wall or otherwise secured.
Contact your Department Safety Coordinator for assistance with
installing seismic restraints. “Q-Brace” seismic restraint guidelines are
available on the EH&S web site
http:// www.ehs.berkeley.edu/qbrace.html
_IIPP–Form 3-Lab, Rev. 9/22/06
Retain completed form in the laboratory for at least one year.
Injury & Illness Prevention Program
Office of Environment, Health & Safety
OTHER HAZARDS
List any other hazardous conditions in need of correction that are not covered on this general
laboratory self-inspection form. Assign and document correction of each hazardous condition or
concern.
1.
_______________________________________________________________________
2.
_______________________________________________________________________
3.
_______________________________________________________________________
OTHER COMMENTS
The space provided below can be used to comment on any conditions described in the above
questions.
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Date_____________________
_IIPP–Form 3-Lab, Rev. 9/22/06
Signature of PI _____________________________________
Retain completed form in the laboratory for at least one year.