PERIODIC WORKSITE INSPECTION CHECKLIST
UNIVERSITY OF CALIFORNIA
AGRICULTURE AND NATURAL RESOURCES
INJURY AND ILLNESS PREVENTION PROGRAM
SITE LOCATION:
DATE:
NAME OF INSPECTOR:
Note to inspector: Some topics on this checklist may not apply to many ANR locations. Use the sections that apply
to your location or operations and draw a line though any section that is not applicable.
SAFETY PROGRAM – Laboratory Safety Self- Audit
Yes
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
No
N/A
Date
Corrected
Chemical Hygiene Plan up to date and in use? ....................................
(1) All laboratory workers familiar with the plan?..............................
(2) Are plans specific to each laboratory? ........................................
Personal Protective Equipment (PPE) available? ................................
(1) Safety goggles/face shield? ........................................................
(2) Chemical resistant gloves/aprons? .............................................
Hazard, PPE requirements and contact information posted at
entrances? ............................................................................................
Compressed gas cylinders properly secured with in-line
flame arrestors (where applicable)? .....................................................
Emergency eyewash/shower units in working order and
unobstructed? .......................................................................................
(1) Within 10 feet of strong acids/corrosives? ..................................
All exits properly identified? ..................................................................
Fume hoods in good operating condition? ...........................................
(1) Certification up to date? ..............................................................
(2) Used for storage of excess chemicals? ......................................
(3) Sashes kept at proper levels? .....................................................
First aid kit(s) located in full view and unobstructed? ...........................
Fire extinguisher(s) in working order and unobstructed? .....................
Spill kit identified and available? ...........................................................
Are lab workers familiar with MSDSs and their location? .....................
Are explosion proof refrigerators available and used only for
flammable materials? ............................................................................
Is housekeeping satisfactory? ..............................................................
Are “No Smoking/Eating/Drinking” signs posted in lab? .......................
Is ventilation adequate? ........................................................................
Are there provisions for the proper disposal of:
(1) Chemical waste? .........................................................................
(2) Biological waste? ........................................................................
(3) Needles and syringes? ................................................................
(4) Radioactive waste? .....................................................................
Is there a designated are for eating and drinking OUTSIDE of the lab?
Is there adequate storage for flammable chemicals? ...........................
Are acids/caustics stored separate from flammables? .........................
Periodic Worksite Inspection Checklist (revised 12/20/2005)
Page 1
T.
U.
V.
W.
X.
Y.
Z.
Carcinogen use areas properly identified? ...........................................
Chemicals/reagents properly identified and stored? ............................
Hazardous waste properly identified and stored? ................................
Only working stock of chemicals in the lab? .........................................
Are there chemicals left over from previous projects?..........................
Are corrosives and caustics in secondary containment? .....................
Appropriate/compatible containers are used to store chemicals? ........
Comments:
ADDITIONAL OBSERVATIONS
Date
Corrected
Periodic Worksite Inspection Checklist (revised 12/20/2005)
Page 2