APPENDIX A FORM LCS-4 Laboratory Chemical Personal Protective Equipment Guidance Form The Occupational Safety and Health Administration (OSHA) requires a personal protective equipment hazard assessment for any tasks that require personal protective equipment (e.g., gloves, safety glasses). Please check all activities that apply to your area. If a task is not listed add a new task at the bottom with the associated hazards and personal protective equipment (PPE). Please complete the hazard assessment for your laboratory and keep it in Appendix A of the Laboratory Safety and Chemical Hygiene Plan. Date: ______Supervisor/PI: ______Assessment by: ______Department: ______Building/Room Number(s): ______Chemical Health Hazards Check All That Task Potential Hazard Recommended PPE Apply Working with small quantities of less toxic hazardous chemicals, Lower risk of potential skin or Safety glasses, light chemically resistant gloves, dilute aqueous solutions, eye damage, or chronic irritants, or sensitizers. (solid or poisoning. lab coat, pants, closed toed shoes. liquid). Working with large quantities of less toxic hazardous chemicals, Higher risk of potential skin or Goggles, light chemically resistant gloves, dilute aqueous solutions, eye damage, or chronic irritants, or sensitizers. (solid or poisoning. lab coat, pants, closed toed shoes. liquid).
Working with small quantities Lower risk of potential skin or Safety glasses, light chemically resistant gloves, moderately toxic hazardous eye damage, and acute or chemicals (solid or liquid). chronic poisoning. lab coat, pants, closed toed shoes.
Working with large quantities Higher risk of potential skin or Goggles, light chemically resistant gloves, moderately toxic hazardous eye damage, and acute or chemicals (solid or liquid). chronic poisoning. lab coat, pants, closed toed shoes. Working with small quantities of Lower risk of potential skin or Safety glasses, appropriate chemically resistant acutely toxic chemicals, eye damage, and acute gloves, lab coat, closed shoe, pants. reproductive toxins, or poisoning. carcinogens (solid or liquid). Note: Must be handled in a chemical fume hood.
Working with large quantities of Safety goggles, appropriate heavy chemically Higher risk of potential skin or acutely toxic chemicals, resistant gloves, lab coat, closed toed shoe, pants eye damage, and acute reproductive toxins, or or coveralls (and booties if necessary). poisoning. carcinogens (solid or liquid). Note: Must be handled in a chemical fume hood. Chemical Physical Hazards Lower risk of potential skin or Working with small volumes of Safety glasses or goggles, light chemically eye damage, poisoning, or organic solvents (< 1 liter). resistant gloves, lab coat, closed toed shoe, pants fire. Working with large volumes of Safety goggles and face shield, heavy chemically Higher risk of potential skin or organic solvents (> 1 liter), very resistant gloves, all-cotton or fire-resistant lab eye damage, poisoning, or dangerous solvents, or work coat, closed shoe, pants, and chemically resistant fire. which creates a splash hazard apron. Note: No synthetic fabric street clothes. Lower risk of potential skin or Safety glasses or goggles, light chemically Working with small volumes of eye damage, and/or resistant gloves, lab coat, pants, closed toed corrosive liquids (< 1 liter). poisoning. shoes Working with large volumes of Higher risk eye or skin Safety goggles and face shield, heavy chemically corrosive liquids (> 1 liter), damage over a large surface resistant gloves, lab coat, pants, closed toed acutely toxic corrosives, or work area, and/or poisoning shoe, and chemically resistant apron which creates a splash hazard Higher risk of skin or eye Blast shield, safety goggles, full face shield, Working with pyrophorics, damage from fire, chemical chemically resistant gloves, fire-resistant lab coat, explosives, or highly reactive exposure, uncontrolled chemically resistant apron, pants, closed toed chemicals. reactions, or flying projectiles. shoes. Note: No synthetic fabric street clothes.
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APPENDIX A FORM LCS-4
Check All That Task Potential Hazard Recommended PPE Apply Safety glasses or goggles for large volumes, Risk of major skin, tissue, Working with cryogenic liquids. heavy insulated gloves, lab coat, closed toed or eye damage. shoes, pants. Risk of frostbite by skin or Working with very cold Safety glasses, insulated gloves and warm eye contact or hypothermia equipment or dry ice. clothing, lab coat, closed toed shoes, pants. in a cold environment. Working with hot liquids, equipment, open flames Risk of burns resulting in Safety glasses or goggles for large volumes, (autoclave, bunsen burner, skin or eye damage. insulated gloves, lab coat, closed shoe, pants. water bath, oil bath). Safety glasses or goggles, appropriate gloves, lab Risk of skin or eye damage, coat, closed toed shoes or boots if necessary, Working with chemical dusts. or respiratory exposure, pants, approved respiratory protection (call irritation, or damage. IUEHS). Safety goggles, appropriate gloves, lab coat, Risk of skin or eye damage, closed toed shoes or boots if necessary, pants, Working in nuisance dusts. or respiratory exposure, NIOSH approved dust mask or other respiratory irritation, or damage. protection (contact IUEHS). Safety glasses or goggles, appropriate gloves, lab Risk of skin or eye damage coat, closed toed shoes or boots if necessary, Chemical spill cleanup. and chemical exposure by pants, approved respiratory protection (contact any route of entry. IUEHS). General Laboratory Hazards Potential for lacerations or Rubber gloves, lab coat, pants, closed toed Glassware washing. dermatitis. shoes. Potential for eye damage Instrument repair. Safety glasses, no loose clothing or jewelry. from foreign objects. Working with loud equipment, Ear plugs or headphones as necessary. (>85 dB Potential for ear damage noises, sounds, alarms, or high requires hearing conservation program, contact and hearing loss. frequencies, etc. IUEHS) Potential eye or skin damage from foreign Safety glasses or goggles, gloves, pants, No Metal or woodworking. objects, lacerations, or loose clothing or hair or jewelry. metal splinters. New Tasks or Other Hazards Check All That Task Potential Hazard Recommended PPE Apply
Exempted Areas (Use the following space to describe protected lab areas where PPE is not required) Check Physical Barrier (i.e. wall, Lab Area Exemption (eyewear, gloves, etc.) All That curtain, lab bench) Apply
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