Promoting Chemical Laboratory Safety and Security in Developing Countries (2010)

Chapter: Appendix F: Sample Forms for Chemical Handling and Management

Previous Chapter: Appendix E: Sample Safety, Health, and Environment Policy Statement
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.

F
Sample Forms for Chemical Handling and Management

The forms in this appendix are to be used in conjunction with the guidelines for establishing a chemical laboratory safety and security program described in Chapter 3.

SAMPLE INVENTORY LOGS

Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.

TABLE F-1 Spreadsheet for Laboratory or Building

Chemical Name and Concentration

Container Type

Location

Responsible Person

Quantity

Allowable Limits

Hydrogen peroxide, 60%

Glass

213 Lab Bldg

P. Jones

4 L

10 L

Dichlorosilane, 100%

Compressed gas

112 Lab Bldg

R. Solli

11 lb

45 lb

TABLE F-2 Container Inventory

Chemical

Location

Responsible Person

Authorized Users

Soman

215 Lab Bldg

P. Jones

P. Jones

L. Martinez

K. Liu

Starting Quantity:

50g

Date Received:

3 June 2009

Date

Amount Removed

Removed by

Quantity Remaining

4 June 2009

2 g

K. Liu

48 grams

5 June 2009

4 g

L. Martinez

44 grams

Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.

LABORATORY HAZARD ASSESSMENT CHECKLIST

I.
Pre-Operational Planning

[ ] Toxicity

What is the level of toxicity? What are the routes of exposure (inhalation, skin absorption, ingestion, injection) and which of these are likely under the conditions of use? What are the signs and symptoms of overexposure?

[ ] Flammability

Is the material flammable or explosive under the conditions of use?

[ ] Warning Properties

Can odor or irritation adequately warn of over-exposure before it becomes dangerous?

[ ] Laboratory Equipment

Is laboratory equipment in good condition? Are machine guards or interlocks in place and functioning?

[ ] Storage Precautions

Does the material need isolated storage, refrigeration or other special conditions for storage?

[ ] Incompatible Materials

Should certain materials be segregated (e.g., flammables and oxidizers)?

[ ] Reagent Stability

Should materials be dated for disposal (e.g., ethers); should materials be kept refrigerated to prolong shelf life?

[ ] Protective Clothing

Is a lab apron or clothing made of resistant material needed or is a lab coat adequate?

[ ] Gloves

What glove material is needed? Are the right type, thickness, glove length, and size available?

[ ] Eye Protection

What type of eye protection is needed—safety glasses for impact, chemical splash goggles for chemicals? Is a face shield needed in combination with the goggles?

[ ] Heat Sources

Is heating needed? Is there an alternative to open flames? Are heating mantles in good condition?

[ ] Electrical Equipment

Is equipment grounded properly? Are electrical cords insulated? Is ground fault circuit interruption (GFCI) needed?

[ ] Vacuum/Pressure Systems

Have connections been leak tested, hydrostatically tested, properly vented, and traps installed when necessary?

[ ] Ventilation/Containment

Does the work need to be done in a chemical hood, ventilated cabinet or a glove box to provide the needed level of containment?

Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.

II.
Experimental Scale & Design

[ ] Quantity

Are there ways to minimize the amount of materials used without affecting results (e.g., microscale)?

[ ] Ambient Conditions

Are special conditions necessary to carry out the reaction (e.g., cold room or dry box)?

[ ] Time Constraints

Can the experiment be completed while lab workers are present? If not, can the experiment be safely run unattended or overnight?

III.
Spill/Emergency Planning

[ ] Lab Personnel

Are others in the laboratory aware of what you are doing?

[ ] Fire Extinguishers

Are special types required; are you aware of their location and proper use (e.g., Class D for metals)?

[ ] Emergency Response

Do you have a response planned in the event of a spill; would evacuation be necessary?

[ ] Spill Cleanup

Are materials on hand to absorb/neutralize; is the needed protective equipment on hand and have you been trained on its use?

[ ] Safety Shower/Eyewash Fountain

Are you aware of the locations and methods of operation?

IV.
Waste Disposal

[ ] Method

Is there an approved method for treating the waste in the laboratory?

[ ] Labeling

Are containers clearly, indelibly, and accurately labeled as to the contents?

[ ] Segregation

Are incompatible wastes kept segregated?

[ ] Containers

Are suitable containers with adequate closures available?

[ ] Recycling

Is it feasible to safely recover/recycle used chemicals?

Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.

SAMPLE FORM FOR SAFETY PLAN

Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.

SAMPLE LABORATORY EMERGENCY INFORMATION SHEET

Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 97
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 98
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 99
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 100
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 101
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 102
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 103
Suggested Citation: "Appendix F: Sample Forms for Chemical Handling and Management." National Research Council. 2010. Promoting Chemical Laboratory Safety and Security in Developing Countries. Washington, DC: The National Academies Press. doi: 10.17226/12857.
Page 104
Next Chapter: Appendix G: Compliance Forms
Subscribe to Email from the National Academies
Keep up with all of the activities, publications, and events by subscribing to free updates by email.