Clearance to Work in Laboratories Form

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Environment, Health & Safety
Risk Management Services
CLEARANCE TO WORK IN LABORATORIES
The Clearance to Work in Laboratories procedure is to be used whenever maintenance, repairs or renovations are required in a
laboratory. The purpose of this procedure is to ensure a safe work environment for maintenance/construction workers. A review by
Environment, Health & Safety (EHS) Office is required when: (1) there is possible radioactive contamination; (2)if the renovation
causes a significant disruption in the laboratory: and (3) for all work in Level 3 Biohazards labs (for work in biohazard lab up to Level
2, designated lab personnel must escort maintenance workers). Some typical examples of renovations include:
• Repair / replacement of large areas of flooring
• Removal of a single laboratory bench
• Removal of a fume hood
For a major renovation which requires the laboratory space to be shut down and would disrupt the performance of regular research
operations for the duration of the renovation, the Laboratory Closeout and Relocation Guidelines must be followed.
This form is to be completed by the Person in Charge of the laboratory at the same time that work is requested through Facilities
Management. The decision chart below indicates the sequence of actions that must be taken in order to have maintenance, repairs or
renovations conducted.
*If biohazard level 2 laboratory, then Person in Charge, or their designate, must escort maintenance or repair workers.
Step 1. Determine what work needs to be performed
Step 2. If the area does not involve possible radioactive contamination or require renovations, arrange to have the requested work
completed in accordance with Facility Management procedures. Ensure area is clear of chemicals, surfaces are free of residues,
experiments have been stopped and obstructions have been removed to allow access. See Clearance to Work in Laboratories Checklist
on page 2.
Step 3. If the area is possibly contaminated with radioactivity or if renovations or major repairs are required, complete the Clearance
to Work in Laboratories Checklist and send it to EHS for a clearance check. When EHS has signed and returned the Clearance to
Work in Laboratories Checklist, post a copy and arrange to have the requested work completed in
* *Facilities Management staff performing the work must follow appropriate safe work procedures e.g. the Guideline for
Maintenance/Minor Repair Work in Laboratories. If there are any questions or if clarification is required, contact your
immediate supervisor, Facilities Management & Utilities safety officer, or the Office of Environment, Health & Safety.
November, 2012
Clearance to Work in Laboratories Checklist
Principal Investigator / Person in Charge
Contact Name
Phone Nbr
Laboratory Nbr
Building Name
Type of Laboratory
Radioisotope
Department
Biosafety
Chemical
Scope of Work
Request Date:
Requested By:
The following refers to the area that will be disturbed by the repair or renovations
Date Complete / NA
All chemical containers and laboratory apparatus have been removed.
All residues on surfaces in the area have been cleaned.
All surfaces have been tested and are free of radioactive contamination
All experiments in the area have been stopped
Obstructions have been removed from the area to allow access
Departmental Sign-Off:
"The area is free of any chemical or radioactive contamination and is now safe for renovation or repair work to proceed".
Researcher/ Person in Charge
______________________________
Signature
Date (dd/mm/yyyy)
Environment, Health & Safety Sign-Off:
____________________________________________
_____________________________________________
___________________
Printed Name
Signature
Date (dd/mm/yyyy)
Disclaimer: The laboratory clearance review is conducted based on the information provided, and, where applicable,
wipe tests conducted for radioactive decontamination and visual inspection of the laboratory during a site visit. Every
attempt has been made to identify, evaluate, mitigate and control potential hazards arising from the laboratory clearance
procedure. EHS is not liable for any discrepancy. Facility & Operations personnel and contractors should perform their
own hazard assessment prior to occupying or working in the laboratory space.
2
November, 2012
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