Cardiovascular Division Laboratory Safety Information Sheet


Laboratory:________________________________________________________
Procedure Name/#:__________________________________________________


                                                           Chemical Hygiene Plan:    Page#s
_____ Personal Protection:
      _____ Protective Clothing: _____ Lab Coat _____ Other __________________    ____________
      _____ Gloves: Type _____________________________________________________    ____________
      _____ Eye Protection: _____ Safety Glasses _____ Safety Goggles             ____________
      _____ Face Protection: _____ Full Face Shield _____ Other ______________    ____________
      _____ Respiratory: _____ Mask _____ Respirator _____ Other _____________    ____________
      _____ Auditory: _____ Ear Phones/Plugs


_____ Ventilation Required:
      _____ Laboratory Hood _____Plus Safety Shield
      _____ Laminar Flow Hood
      _____ Special Ventilation Area _____ Glove Box _____Other ______________    ____________
      _____ Other ____________________________________________________________    ____________


_____ Chemical Hazard:
      _____ Caustic or Corrosive Acids/Bases _________________________________    ____________
      _____ Flammables _______________________________________________________    ____________
      _____ Explosives _______________________________________________________    ____________
      _____ Poisons __________________________________________________________    ____________
      _____ Carcinogens ______________________________________________________    ____________
      _____ Mutagens/Teratogens ______________________________________________    ____________
      _____ Other ____________________________________________________________    ____________


_____ Biological Hazards:
      _____ Blood Product ____________________________________________________    ____________
      _____ Infectious Agent _________________________________________________    ____________
      _____ Other ____________________________________________________________    ____________


_____ Fire Hazard: ___________________________________________________________    ____________


_____ Electrical Hazard: _____________________________________________________    ____________


_____ Compressed Gases:
      _____ Toxic ____________________________________________________________    ____________
      _____ Flammable ________________________________________________________    ____________
      _____ Other ____________________________________________________________    ____________


_____ Radioactive Chemicals: (See Radiation Protection Handbook)
      _____ Type of Radiation: _____ Alpha _____ Beta _____ Gamma _____ X-rays
      _____ Shielding Required _____ None _____ Plexiglas _____ Lead _________________________
      _____ Bench Protection: _____ Plastic-backed Paper _____ Tray _____ Other ______________


_____ Hazardous Waste: (Special Handling)(See Hazardous Chemical Management Handbook)
      _____ Blood Products ________________________________________________________
      _____ Hazardous Chemicals ___________________________________________________
      _____ Radioactive Waste _____________________________________________________


_____ Other Hazards: ____________________________________       CHP Pages#s:     _____________