University Health and Safety

Laboratory Safety Self Inspection Form

Date:

Lab Name: Department:

Building: Room(s) Inspected:

PI/Primary Contact: Lab Manager: Phone Number: Phone Number:

Email: Email:

RSO: Phone Number:

Email:

Inspected By:

Lab Type: Clinical/Diagnostic Teaching Research

Rev: 2016 Page 1

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A. Laboratory Information (required) Yes No N/A Resources/Comments A1. Are hazardous chemicals present in the lab?

(if yes, complete section C) OSHA Guidance for Hazard Determination

A2. Are biological agents or biological toxins present in the lab? (if yes, complete section D)

For guidelines: refer to BMBL Lab Biosafety Level Criteria tools.

A3. Are controlled substances present in the lab? (if yes, complete section E)

Policy: Controlled Substances in Research

A4. Is radioactive material or ionizing radiation used in the lab? (if yes, complete section F) When were you last inspected by the Radiation Protection Division (RPD)?

UHS Radiation Safety

B. Safety Programs and Plans (required) Yes No N/A Resources/Comments B1. Is there documentation of required training at initial hire?

Minimum requirements initial training: Introduction to Research Safety, Chemical Safety, Chemical Waste Management GHS Classification and Labeling

Bloodborne Pathogens Training (Into and Advanced)-if work involves bloodborne pathogens, human/primate materials (e.g. blood, body fluids, unfixed tissues, cell lines, etc.) or infectious agents (viruses, bacteria, fungi, rickettsia, prions)

UHS Training Resources

Bloodborne Pathogen Exposure Program

The PI and/or Laboratory Director is responsible for ensuring that training is provided for all hazards in the laboratory to comply with OSHA Lab Standard.

B2. Is there documentation of required training at initial hire, with updates provided at least annually?

Ongoing annual requirements: Lab Specific Training (Provided by PI or Lab Manager) Update Training (Departmental) Bloodborne Pathogens Training (Intro and Advanced) if work involves bloodborne pathogens and /or human materials*

Additional training may include: Working alone in the lab Shipping Hazardous/Infections Material (including Dry Ice) Controlled Substances, Radiation, Animal Handling, Biological and Infectious Waste, Handling Dry Ice/Liquid Nitrogen, Biological Safety Cabinets, Fume Hoods, Autoclave, Centrifuges, Other Laboratory Equipment, IBC’s Implementation of NIH Guidelines IBC’s Biological Safety in the Laboratory Working with Toxins of Biological Origin

*Bloodborne Pathogen training is required annually for anyonewho will work with human materials (e.g. human blood, human body fluids, unfixed human tissue or organs, human cell lines, etc.).or bloodborne pathogens (e.g. HIV, HBV, HCV, etc.). If you work with infectious agents other than human materials and bloodborne pathogens, Bloodborne Pathogen Training is only required initially.

Lab Specific Safety Training includes review of SOPs as well as review of safe equipment operation and general lab safety.

Bloodborne Pathogen Exposure Program

IBC Training Web Site

Controlled Substances in Research

Working alone in the Laboratory Fact Sheet

Implementation of NIH Guidelines is required for research involving rDNA or synthetic nucleic acids

Biological Safety in the Laboratory is required for research requiring IBC review and approval

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B3. Are food, beverages, and cosmetics prohibited from being stored, consumed, or handled in laboratory and clinical space?

Prudent Practices, page 82: Avoiding Ingestion of Chemicals MMWR Safe work practice in animal medical diagnostic labs BMBL: Standard Microbiological Practices (section IV, A)

B4. Do personnel wear appropriate protective clothing and close toed shoes when working in labs or animal areas?

Shorts are prohibited in research labs. Long hair, scarves, ties, etc., must be secured to prevent injury/contamination. Proper Lab Attire Fact Sheet

B5. Have you evaluated your procedures to ensure that the appropriate PPE is being used?

UHS PPE Guidance UHS Equipment and Protective Clothing Guidance Glove Selection and Use U-Wide Contracts for Laundry – Lab Coats Respiratory Protection Program

B6. If lab staff wear respirators (including N95 filtering facepieces) have their exposure levels been evaluated by the PI or UHS? Contact UHS at 6-6002 to have

exposure levels tested B7. If exposure levels may exceed Permissible Exposure Limits

(PEL) or if the use is required by the PI or in an SOP, are users of respirators enrolled in UMNs respiratory protection program (RPP)?

Respiratory Protection Program Permissible Exposure Limits Voluntary use of an N95 filtering facepiece is exempt from the requirements of the RPP

B8. If lab staff wear hearing protection have their noise exposure levels been evaluated by the PI or UHS? Contact UHS at 6-6002 to have

exposure levels tested B9. If sound levels may exceed noise exposure limits are users of

hearing protection devices enrolled in UMNs hearing conservation program?

Occupational Noise Exposure Hearing Conservation Program

B10. Is the Lab Safety Plan (LSP) current (within one year), readily available, and reviewed with all staff?

Lab Safety Plan (LSP) The Lab Safety Plan should be customized to your area/department by your DSO

B11. If the lab will be closing, are you aware of the Lab Closeout Plan for orderly shutdown? Lab Closeout Plan

B12. If you have minors or volunteers coming into your lab, are you

following the UMN Procedures for Minors and Visitors? Minors in the Laboratory or Other Hazardous Areas Volunteers and Visitors Lab Agreement

B13. Are hazardous materials/animals/substances transported through public areas regularly? If so, are proper precautions observed?

Prudent Practices – Transport of Chemicals Moving Hazardous Chemicals

B14. Have you evaluated your waste streams to ensure that the proper methods are being used?

Biological Waste Disposal Table Biohazardous and Pathological Waste Management Plan Biological Waste Summary Poster Hazardous Chemical Waste Management Guidebook Radioactive Waste Manual Facilities Management Waste Guide

B15. Is equipment decontaminated before it is serviced or removed from the lab for repair, ReUse, or disposal? ReUse Program Instructions

B16. If pipetting is performed, are mechanical devices used? (Mouth pipetting is prohibited)

B17. Is plasticware substituted for glassware whenever possible? B18. If research animals are anesthetized in the laboratory via gas

anesthetic, is an approved method for scavenging waste anesthetic gas used? (i.e., fume hood, local exhaust, gas absorption canister)

Nonflammable Anesthetic Gases

Rev: 2016 Page 3

B19. If absorbent canisters are used for waste anesthetic gas, are they being weighed and recorded after each use? Nonflammable Anesthetic Gases

B20. Are safety issues addressed in Standard Operating Procedures

(SOPs) where appropriate?

UHS Chemical SOP Template SOP Resources ACS SOP/Hazard Assessment UHS Biological SOP Template

B21. Do you have SOPs in place to deal with biological or chemical spills in your laboratory, and are employees trained to respond appropriately? (for example, chemical and/or biological spill kits; escalation to UHS if required)

Spill kits are available through UMarket. ACS Chemical Spill Guide UHS Decontamination Template

B22. Are procedures in place for the clean-up (use of dustpan, brush, and forceps) and disposal (glass disposal box, sharps container) of non-contaminated broken glassware?

UHS Glass Disposal Guidance

B23. Are lab personnel familiar with incident reporting procedures including the First Report of Injury (FROI)? (e.g. injury, worker’s comp, student, non-staff, etc.)

Injury Reporting Procedure Reporting incidents involving Biological Substances

B24. Does the lab have an emergency procedures plan posted at the lab exit, and have staff been trained in the procedure? Emergency Procedures Plan Template

B25. Are eyewashes available, accessible, and flushed weekly (2

minute flush), with a record of weekly flushing? Date of last FM annual inspection:

Eyewash Guidance and Testing Log

B26. Are safety showers available and accessible? Date of last FM annual inspection: How to use Emergency Shower-video

B27. Are sprinkler heads unobstructed? (18” clearance around heads) B28. Are chairs and stools in the lab impervious to liquid and in good

condition?

B29. Are the entrances to the lab posted with updated universal Lab Signage which identifies the specific hazards in that space? Lab Signage Templates and Instructions

B30. Is there a hand washing sink available in the laboratory and do employees properly wash their hands after removing gloves and before leaving the lab?

UHS Personal Protective Measures BMBL Lab Biosafety, Including Hand Washing Rules

B31. Are first aid kits available, accessible, properly stocked, and their location marked? First aid kits are available through

UMarket. B32. Electrical Safety

No cords across aisles Electrical cords in good condition Extension cords are not used in place of permanent wiring GFCI on outlets within 6’ of sinks, or wet areas Power strips not daisy-chained live circuitry is enclosed High wattage equipment on dedicated circuits Equipment does not exceed wattage ratings for cords or circuits

Electrical Safety Fact Sheet

B33. Is critical equipment plugged into outlets with an emergency power backup?

B34. Are appropriate fire extinguishers available, accessible, properly mounted, and have they been inspected within the past year?

Fire Extinguisher Fact Sheet Call FM at 4-2900 if fire extinguishers are overdue for annual inspection

B35. Are aisles, passageways and exits clear from obstructions and trip hazards? Housekeeping Fact Sheet

B36. Are compressed gas cylinders securely and properly restrained,

capped when not in use, and away from heat sources? Prudent Practices – Cylinder Handling

B37. Are distribution panels and emergency shut-offs (gas and electric) unobstructed?

B38. Are the laboratory doors kept closed at all times, and locked when workers are not present? Prudent Practices – Laboratory Security

B39. Are valuables, controlled substances, equipment, select agents and supplies properly accounted for and losses reported to the appropriate agency (e.g. UM Police, UHS, etc.) according to University policies?

UMPD - Reporting a Crime

B40. Is UMN property, including keys and badges, accounted for when workers leave or change laboratories?

Change access codes and passwords as needed.

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C. Chemical Safety Yes No N/A Resources/Comments C1. Are high hazard chemicals covered in Standard Operating

Procedures?

Prudent Practices – Evaluating Hazards UHS: High Hazard Chemicals (also see tables 1-5 in LSP)

C2. Are SDSs for all hazardous chemicals readily accessible? Online – bookmarked Printed

SDS Resources

C3. Are chemical and lab-prepared reagent containers legibly labeled according to University guidelines?

Chemical Labeling Guidelines

C4. Are all areas (e.g., storage cabinets, shelving, floor tiles, etc.) in good working order? (if not, please contact Facilities Management)

Call FM at 4-2900

C5. Are Fume Hoods functional, free of clutter, and certified within the last 12 months?

Fume hood fact sheet

C6. Are chemicals of incompatible hazard classes kept separated in storage? (acids / bases / oxidizers / organics)

Storage Poster (based on DDC) Storage Instructions

C7. Are flammable chemicals stored in properly labeled cabinets, refrigerators or freezers rated for flammable material storage?

C8. Are peroxide formers (ethers, aldehydes, compounds with benzyllic hydrogens, allylic compounds, vinyl compounds, etc.) dated when received and when opened (Test or discard every 6 months)

Peroxide Forming Chemicals Storage, Testing, and Disposal LSP Peroxide Forming Chemicals List

C9. Are perchloric acids heated only in fume hoods with washdown systems?

Perchloric Acid Fact Sheet

C10. Is tax-free ethyl alcohol in lab used according to University requirements?

UHS Alcohol Order Procedures UMarket Alcohol Ordering Procedures UMarket Alcohol Ordering Form

C11. Are stench chemicals used or generated in a manner that will prevent releases?

Stench Chemical Fact Sheet

C12. Are Chemicals of Interest used in your lab and reported to UHS? Chemical Security

Chemicals of Interest List C13. Is chemical waste properly stored (accurately labeled, closed

except when actively adding waste, and in secondary containment), documented and packaged for disposal according to UHS guidelines?

Hazardous Waste Guidebook Labeling Chemical Waste Chemical Waste Poster

C14. Are proper waste containers used for high-risk chemicals (i.e., yellow barrels for carcinogen contaminated waste, etc.)

Waste Handling Procedures Chemo Waste Handling

Rev: 2016 Page 5

D. Biosafety Yes No N/A Resources/Comments D1. Do lab personnel know how to access the Biosafety Manual and

have they reviewed all pertinent sections of the manual? Biosafety Manual

D2. Indicate which Risk Group(s) corresponds to the highest risk group material used in your laboratory:

Risk Group 1; Risk Group 2

Risk Group Definitions Example Risk Group agents

D3. Is this lab BSL/ABSL rated? What biosafety level 1; 2

For guidelines: refer to BMBL Lab Biosafety Level Criteria tools. Note: All biological toxins should be handled under BSL 2 containment

D4. Do lab personnel update their Bloodborne Pathogen training annually if they work with any of the following? Human Bloodborne pathogens (e.g. HIV, HBV, HCV, etc.) Human or NHP blood/blood components OPIM (Other Potential Infectious Materials):

Human body fluids Unfixed human tissues/organs Cell/tissue/organ culture containing HIV or HBV blood, organs, or other tissues from experimental animals infected with HIV or HBV Human cell lines (primary or established)

Working with Human/Other Primate Cells, Tissues, or Human Derived Products – Fact Sheet OPIM includes human body fluids, and unfixed human tissue or organs, human cells, etc. BBP training

D5. Has IBC approval been obtained if you use any of the following? Recombinant and or synthetic nucleic acids Artificial gene transfer Infectious agents (infectious to humans, plants, or animals) Biologically Derived Toxins Pre-generated animals, cells, or agents stably containing r/sNA that were purchased provided or already made

Consult with IBC for information: http://www.research.umn.edu/ibc/ IBC – Forms for Infectious Agents, rDNA and Biologically Derived Toxin Occupational Health risk Assessment Guide for IBC Research IBC Web Page

D6. Do you have biohazard labels on areas where infections agents, biological toxins, and recombinant or synthetic nucleic acids are being used or stored (e.g. freezers, refrigerators, incubators, centrifuges, BSCs, etc.)?

Preprinted labels available through UMarket Printable biohazard label

D7. Do you ship or receive biological materials? (if yes, see the Infectious Substance Classification flow chart in the Biosafety Manual.)

Infectious Substance Flow Chart Note: Contact UHS for training UHS@umn.edu 612-626-6002

D8. Has the laboratory filled out a Decontamination and Spill Template? Decontamination Template

D9. Is biohazardous waste, including contaminated clinical materials, separated from non-hazardous waste at the point of generation and subsequently disposed of according to UMN Biosafety policies?

Biological Waste Disposal Table Biological Waste Disposal Plan Template

D10. Are biohazardous waste bags filled less than 2/3 full and secured properly?

Note: If the biohazardous waste is not regularly picked up by custodial staff, call FM at 4-2900.

D11. Are biohazardous waste containers leak-proof, covered, and properly labeled with biohazard sticker? UHS Infectious and Pathological Waste

Management Plan D12. Liquid and solid biohazardous wastes are decontaminated by:

Chemical disinfection: Disinfectant(s) Used: Autoclave location: Bldg.: Room: Placed in red bags for off-site disposal

Biological Waste Handling Procedure Note: If you autoclave waste, the bags must be clear. Red bags are for biohazardous material that will be decontaminated offsite.

D13. Are indicators/integrators used at least monthly to ensure proper operation of the autoclave, and are autoclave procedures validated and performance tested, with results recorded in a log and kept where all users can access? What type of indicator/integrator is used?

Autoclave Safety and Effectiveness Autoclave Log

Rev: 2016 Page 6

D14. Is a current pathogen inventory maintained in the lab? D15. Does your lab use “Exempt Select Agents”? Permissible Toxin List

Select Agent and Toxins Exclusions List D16. Do you have a Biological Safety Cabinet (BSC)?

Date of last annual certification:

BSC/Fume Hood Guidance BSC Certification Note: BSCs must be certified annually for work at BSL-2.

D17. Are laboratory staff trained in the proper use of the BSC? Safe and effective work practices Biosafety Cabinet Presentation

D18. Are procedures with a potential for creating infectious aerosols or splashes conducted within biological safety cabinets and/or conducted using appropriate PPE and environmental controls and written into the SOP?

D19. Are the walls of the BSC unaltered, and the front and back grills unobstructed by equipment? Biological Safety Cabinets

D20. Are unnecessary/extra supplies and equipment kept out of BSC? BMBL Appendix A

D21. Are vacuum lines protected from contamination with a

disinfectant trap and an in-line HEPA filter? (Note: vacuum line HEPA filters in BSC’s must be inside of the cabinet)

UHS Vacuum Equipment Setup

D22. Are cell culture vacuum traps labeled with chemical contents and hazard communication, e.g. “bleach-corrosive”?

D23. Are work surfaces and equipment, including biological safety cabinets, decontaminated when work with infectious material is finished and immediately after spills or splashes? Disinfectant(s) Used: Concentration:

Decontamination and Disinfectants

D24. Do you wipe down the surfaces of all containers and equipment with disinfectant before removing from BSC? Biosafety Cabinet Work Practices

D25. If UV lights are used, are they only secondary to disinfectant and the practice of good aseptic technique? UV lights

D26. Does the lab use only Luer lock syringes or disposable syringe-needle units (i.e., needle is integral to the syringe) for injecting or aspirating infectious materials?

Sharps Safety

D27. Is recapping of sharps avoided where possible? If recapping is necessary, it must be justified in your SOP.

D28. Are approved sharps containers with lids available for used syringes, needles, scalpels, etc.? Sharps Fact Sheet

D29. Are centrifuges equipped with sealed secondary containment

that is only opened in the BSC? If not available, are staff trained in alternative safety measures that are written in the SOP(e.g., waiting 10 minutes before opening)?

Centrifuge Safety

D30. Are contaminated gloves disposed of as biohazardous waste? This includes gloves used for recombinant and synthetic nucleic acid molecules.

D31. Does the lab supervisor ensure that lab personnel demonstrate proficiency in standard and special microbiological practices before being assigned work with Risk Group 2 agents?

Example Risk Group 2 agents

D32. Have laboratory personnel received all appropriate immunizations prior to beginning work in the lab?

Working with Animals BBP & Hepatitis B Vaccination (Bloodborne Pathogen Exposure Control Plan - Section X)

D33. Are laboratory personnel, particularly women of child bearing age, provided with information regarding immunocompetence and conditions that might predispose them to infection?

BMBL: Standard Microbiological Practices (section IV, A-11)

D34. Is shared equipment such as centrifuges and biological safety cabinets disinfected after each use?

D35. Are non-research animals and plants prohibited from BSL-2 labs? BMBL Section IV

Rev: 2016 Page 7

D36. Are open flames prohibited from being used in BSC? Open Flames in BSC fact sheet D37. Are standard microbial and special practices being followed for

research activities involving Animal Biosafety Level 2? BMBL: Animal Biosafety

D38. Is there a Biohazard sign posted on the door(s), if animal infectious agents or biological toxins are present in the cell culture room of RAR procedure space?

For Research or Teaching Labs Only: Please include information about any Risk Group 1 or greater material you work with (including attenuated lab and vaccine strains), microorganisms used for recombinant and synthetic nucleic acid molecules work, and biologically-derived toxins that are used or stored by your laboratory. IBC approval is required for the use of any of these materials. All recombinant and synthetic nucleic acid molecules work requires IBC approval regardless of the biosafety level, (see the IBC web page http://www.research.umn.edu/ibc/)

Material Biosafety Level

Is This Material: Actively Used Stored

IBC Approval Number

IBC Approval Date

E. Controlled Substances Yes No N/A Resources/Comments E1. Are controlled substances stored in an approved safe, and are

inventory and usage records complete and up-to-date? Policy for Controlled Substances

Guidelines for controlled substances use E2. Are all authorized staff trained in the management of controlled

substances? Guidelines for controlled substances use (tutorial)

E3. Does lab staff know how to contact UHS to obtain slurry bottles for controlled substance waste?

Disposing of Controlled Substances

F. Radiation Safety Yes No N/A Resources/Comments F1. Do you have radiation warning labels on areas where radioactive

materials are being used or stored? e.g. freezers, refrigerators, incubators, centrifuges, fume hoods

F2. Are rights of employees posted? (Required - available from UHS Radiation Safety Dept.)

F3. Are radiation badges required? (Anyone under 18 is required to have a badge, and minors are forbidden from handling any radioactive material.)

F4. Is radiation safety training completed? F5. Is isotope usage tracked from receipt through disposal? F6. GM meter has test source for checking meter function?

G. Other Comments / Summary of Comments (Optional) G1. G2. G3. G4. G5. G6. G7. G8. G9. G10.

Rev: 2016 Page 8

Helpful Resources:

A library of references fact sheets and forms are available at: www.z.umn.edu/labsafe

General Resources Lab Closeout Plan

Lab Hibernation Checklist

Prudent Practices in the Laboratory (National Academies Press)

Workers Compensation

Respiratory Protection Program

Secondary Containment Trays from UMarket: CX18997 TRAY FOR SECONDARY CONTAINMENT/SEPARATION OF CHEMICALS-24 1/4 X 20 1/4 CX18998 TRAY FOR SECONDARY CONTAINMENT/SEPARATION OF CHEMICALS-17 7/8 X 14 5/8 CX18999 TRAY FOR SECONDARY CONTAINMENT/SEPARATION OF CHEMICALS-20 7/8 X 17 3/4

TOXNET: Toxicity Database, The United States National Library of Medicine

CCOHS: Canadian Centre for Occupational Health and Safety, Web based collections of MSDS, CHEMpendium, RTECS (Registry of Toxic Effects of Chemical Substances), etc. (UofM maintains a license to access this information.)

Training Resources: UHS Training Locator

Emergency Planning Worksheets: Biological Spills Chemical Spills Needle Sticks

Signage Lab Signage templates and instructions

Emergency Procedures Plan Template

Eyewash Testing Log

Chemical Safety Chemical Labeling Guidelines

SDS Resource (UHS)

Chemical Management in the Lab (link to Prudent Practices in the Laboratory, chapter 4):

School Chemistry Laboratory Safety Guide (CDC)

ACS Identifying and Evaluating Hazards in Research Laboratories

Limits to Exposure to Toxic & Hazardous Substances

Alcohol Ordering Procedures – UHS Information Sheet

Rev: 2016 Page 9

Biosafety Autoclave Safety and Effectiveness Bio Basics Fact Sheets Biological Safety Cabinets, Vented Hoods, Laminar Flow Hoods, Etc. BMBL (CDC) – Biosafety in Microbiological and Biomedical Laboratories Biological Material Storage Biological Waste Disposal Plan Biological Waste Disposal Table Biosafety in the Laboratory: Prudent Practices for Handling and Disposal of Infectious Materials Infectious and Pathological Waste Management Plan Administrative Policy: Activities Involving Potential Hazardous Biological Agents Administrative Procedure: Activities Involving Potential Hazardous Biological Agents Primary Containment for Biohazards: Selection, Installation and Use of Biological Safety Cabinets (CDC) Select Agent policies and information

Radiation Safety Radiation Forms Notice to Employees sign

Rev: 2016 Page 10