UNIVERSITY OF SOUTHERN CALIFORNIA
Environmental Health and Safety
Check List for Certificate of Environmental Compliance (CEC)
Project Information
Principal Investigator:
Project Title:
Funding Agency or Source:
Please indicate which of the following describes the scale of your proposed project?
__ Laboratory Research: Location of your lab (building/room): ________________________
__ Pilot or Proof-of-Concept Scale Research
__ Full-Scale Demonstration
__ Bench-top Scale Research
__ Data analysis including computer sciences/modeling or applied mathematics
__ Pilot Plant Construction/Operation
__ Field Research: Field Location_____________________
__ Other (briefly describe project):
Will the proposed action involve any of the following items or activities?
__ Chemical use/storage. If checked, please list chemicals used for this project, including pesticides:
_____________________________________________________________________________
_____________________________________________________________________________.
I certify that my chemical inventory is current & accurate:
Signature: ______________________________ Printed Name: _____________________________
To open a chemical inventory account, contact Michelle Lee: mlee@caps.usc.edu 323-864-3188, or
Alfred Bouziane: abouzian@caps.usc.edu 213-923-507.
__ Infectious or potentially infectious materials (Biosafety Level 2 or 3 Agent). Describe: _______
_____________________________________________________________________________.
 http://www.absa.org/riskgroups/index.html
 http://oba.od.nih.gov/oba/rac/guidelines_02/APPENDIX_B.htm
__ Human or Primate Cell, Tissue, Blood, or Blood Products. Describe: _____________________
__________________________________________________________________________
__ Recombinant DNA Material, e.g., plasmids or viral vectors. Describe: ____________________
_____________________________________________________________________________
(If my research involves an above biological agent) I certify that I have a current Biohazard Use
Approval from the Institutional Biosafety Committee (IBC) that includes all agents listed above.
Signature: ______________________________ Printed Name: _____________________________
 http://capsnet.usc.edu/LabSafety/BioSafety/IBCSection/index.cfm#IBCresources
 Questions? Contact EHS Biosafety Office at IBC@caps.usc.edu or 323-442-2200.
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__ Use radiation or radioactive materials. List materials or type of radiation producing equipment:
__________________________________________________________________________
I certify that my Radiation Permit is current and accurate:
Signature: ______________________________ Printed Name: _____________________________
 http://capsnet.usc.edu/LabSafety/RAD
 Questions: Contact EHS’ Radiation Safety Office at 323-442-2200 or dwesley@caps.usc.edu.
__ My research may create an occupational or environmental concern, e.g., noise, dust, heat, cold.
__ My project entails a tenet improvement or space modification that may potentially disturb asbestos
or lead paint (e.g., removal of old paint, interior wall or counter top).
 Facility Management: http://www.usc.edu/fms 213-740-6833.
__ Import or manufacture a toxic substance; list material: ________________________________.
 Contact Michelle Lee, Environmental Safety Specialist, at 323-864-3188 for further information.
__ Manufacture, Purchase, or Use of Nano materials. List nanomaterials: _____________________
___________________________________________________________________________
__ Use of Controlled Substances. List substances: ________________________________________
__________________________________________________________________________
__ My research staff attended or is enrolled in Lab Safety Training and Annual Refresher Training.
__ My lab follows USC’s Hazardous Waste Generator Guidelines.


http://capsnet.usc.edu/LabSafety/images/wastecontainerflowchart.jpg
http://capsnet.usc.edu/LabSafety/chemicalsafety/documents/HazWasteManDisp.pdf
I hereby certify that the information provided above is current, accurate and compete as of the date
noted with my signature:
Name ___________________________
Signature _________________________ Date ____________
Environmental and Health Safety (EHS) Only
__ Chemical Inventory Account
__ IBC Approval
__ Radiation Committee Approval
__ AQMD Permit (scrubber)
__ Department of Homeland Security Interest Chemical: __________________________
__ Highly toxic or Regulated Carcinogen or Substances: ___________________________
Comments: ______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Approved _____
Review Date:
Not Approved _____
In Progress _____
_______________________
Name of Reviewer: _______________________ Signature :
_____________________________
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