Laboratory No.                   Bldg.                            Inspected by__________________________Date______________

Areas of Inspection                                                                             Comments and Recommendations
1.   Bench tops                                                     ____
2.   Areas under sinks                                                ____
3.   Cabinets, drawers, shelves (chemicals storage)____
4.   Hoods                                                          ____
5.   Aisles                                                                    ____
6.   Window ledges                                            ____
7.   Walls, floors                                          _____
8.   Chairs, stools, upholstery, casters              _____
9.   Safety glasses, face shields, protective clothing_____
10. Fire Extinguishers                                           _____
11. Compressed gas cylinders                         ______
12. Broken glassware: destroy? repair?              _______
13. No Smoking sign                                           _____
14. Tubing: condition? proper use?       _____
15. Guards on moving equipment                    ___
16. Interlocks                                                        ___                                                                                _
17. Condition of laboratory equipment           ___
18. Refrigerators                                         ______
19. Electric cords, other wiring                       _____
20. Eye wash fountains                                                                                                                    _____
21. Storage of peroxide-forming chemicals    _____
22. Labels on containers                                                                                                                 _____
23. Evaluation of amount of chemicals in laboratory                                                                                   _
24. Evaluation of amount of supplies and equipment     ____________________________________________
25. Laboratory desks, bookshelves                                                                                                  _____
26. Office Housekeeping                                                                                                                      _____
27. Other                                                                                                                                                       _____

Actions taken and other recommendations:
1.   ___________________________________________________________________________________
2.   ___________________________________________________________________________________
3.   ___________________________________________________________________________________
4.    ___________________________________________________________________________________
5.    ___________________________________________________________________________________
6.    ___________________________________________________________________________________
7.    ___________________________________________________________________________________
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