Permit Request • CampusOptics

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date

Expiration Time

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Laboratory Documentation

PI Name * Required

Location Of Laboratories* Required

What hazards are utilized in your lab? (Please select all that applies) * Required

Biological Hazards
Chemical Hazards
Refrigerators/Freezers/Microwaves
Compress Gas
Lasers
Radiation
Sharps

The following emergency information posted in a visible location? * Required

Updated door sign acknowledging internal hazards
Laboratory Emergency Contacts
Small Quantity Generator emergency half sheet (If necessary)
Emergency Response Guide

The following documentation is readily accessible (if applicable) * Required

Chemical Hygiene Plan
Safety Data Sheets
Institutional Biosafety Committee Protocol
Infectious Agent Fact Sheets

Biosafety

Does the research area have a protocol with the Institutional Biosafety Committee?

Is a biological spill kit available?

Is there a sink with soap and paper towels for hand washing?

Is there a biosafety cabinet in the laboratory?

The following safe biosafety cabinet practices are being used

The biosafety cabinet has been certified within the last 12 months
The biosafety cabinet is free of clutter and not overloaded
The biosafety cabinet vacuum lines have an in-line HEPA filter
Open flame devices are not being used within the biosafety cabinet
The biosafety cabinet vacuum trap is properly labeled and free of contamination

Is biohazard solid waste being generated?

Is biohazard waste disposal being properly utilized? * Required

Chemical

Are chemicals utilized in the space?* Required

Are there any surplus or unwanted chemicals?* Required

The following safe chemical practices are being used * Required

All chemical containers are in good condition
All chemical containers are properly closed
All chemical containers are labeled properly
All chemicals are properly barcoded for the RMM system
Chemicals are stored at an appropriate height (Not stored on shelves higher than 5 feet or on the floor)

Are P-listed chemicals present in the lab?* Required

The following of the waste containers are true * Required

All waste containers are fully closed and in good condition
Waste is collected in a waste-designated container
All chemical waste containers are properly and fully labeled (special, non-hazardous, hazardous, ignitable, corrosive, reactive, toxic, and/or oxidizer)

Hazardous chemicals are not stored under or in the sink * Required

The following safe compressed gas practices are being used

Cylinders do not appear to be damaged
Cylinders are secured
Cylinders are marked with hangtags indicating: Full, In Use, or Empty
All cylinders are equipped with a regulator or cap
All cylinders are labeled
Cylinders are segregated by hazard class
Cylinders are stored away from heat and electrical sources
All connections are in good condition, free from cracks, holes, and other damage

Does the laboratory have any tools or equipment containing mercury (Hg)?* Required

Housekeeping

The following facilities are in working order * Required

All ceiling tiles are in place and in good condition
Trash is being disposed of properly
All lights are in working order

Food and drink are not stored or used in the lab area * Required

The following is true of the working area * Required

All work areas are clear of clutter
All floors and aisles are clear with no slips, trips, and fall hazards present
Nothing is closer than 18 inches to the sprinklers
Nothing is closer than 3 feet to electrical panels
All chairs are made of non-porous materials
All machine guards are in place, in good condition, and functional

The following fire hazards are being mitigated * Required

There is clearance of at least 18 inches maintained around fire sprinkler heads and 2 feet below the ceiling height
All flammable cabinets are free of combustible materials (cardboard, paper, wooden crates, etc.)
Combustibles are not stored in excess amounts (cardboard, paper, wooden crates, etc.)
Bunsen burners or other high-heat tools are not being used in the vicinity of other fire hazards

The following electrical hazards are being mitigated * Required

Access to the electrical panels is clear (3 feet of clearance)
The electrical panel door fully closes
Extension cords are not being used permanently
Power strips are being used correctly (not overloaded, no extension cords or additional power strips plugged into them)
Power strip cords are intact and in good condition
Emergency poewr outlet are marked and used correctly

Refrigerators, Freezer, and Microwave Safety

The following safe refrigerator practices are being used

The refrigerator is appropriately labeled for use (lab use only, no food or drink)
All containers within the refrigerator are properly labeled
No food or drinks are stored in laboratory refrigerators
There is no evidence of spills within the refrigerator
All containers are in good condition and stored in an upright position

The following safe freezer practices are being used

The freezer is appropriately labeled for use
All containers within the freezer are properly labeled
No food or drinks are stored in the laboratory freezer
There is no evidence of spills within the freezer
All containers are in good condition and stored in an upright position
The freezer is periodically defrosted

The following safe microwave practices are being used

The microwaves are appropriately labeled for use
Microwaves are clean and in good working condition

Eyewashes and Safety Showers

The following safe eyewash practices are being used* Required

An eyewash is located within the lab
The eyewash has a current annual inspection tag
Visible signage is posted to help locate the eyewash
The eyewash is easily accessible and free from obstruction
The eyewash is tested weekly and record of test is visible

The following safe safety shower practices are being used * Required

A safety shower is present within the lab
The safety shower has a current annual inspection tag
Visible signage is posted to help locate the safety shower
The safety showeris easily accessible and free from obstruction

Fume Hood

A fume hood is utilized within the lab * Required

The following safe fume hood practices are being used

The fume hood has a current annual inspection sticker
The fume hood sash moves easily and stays at the appropriate height unaided
The bench within the fume hood is in good condition
The hood is clear of clutter, with no items blocking the airflow

Are there any other types of engineering controls within the lab?

Elephant trunk exhaust
Canopy Hood
Slot Hood
Laminar Flow Hood
Downdraft Table
Glovebox
Ductless Fume Hood
Perchloric Acid Fume Hood

Personal Protective Equipment (PPE)

The appropriate PPE is available for use * Required

The following PPE is utilized in the lab* Required

Gloves (nitrile or comparable)
Cut Resistant Gloves
Safety Glasses
Safety Goggles
Face Shields
Lab Coat or other protective clothing (Tyvek, etc.)
Shoe Covers

Laboratory workers are using the appropriate PPE for the hazards present * Required

Laser/ Radiation/ Sharps Safety

The following safe laser practices are being used

Proper signage is posted on the device
Class 2 or Class 3A/3R have CAUTION signs posted outside the lab
Class 3B or Class 4 has DANGER signs posted outside the lab
Laser safety eyewear is available

If radiation is being utilized in the laboratory, signs are posted on the door as well as Radiation Safety Office contact information.

Yes
No, the Radiation Sign is missing from the door
No, Radiation Safety Office Contact information is missing from the door

The following safe sharps practices are being used

Appropriate sharps containers are being used for disposal
Sharps are not lying open on the benchtop
If available safety engineered sharps are being utilized

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

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