Laboratory Safety Procedure Template

This template form is available at:

Keywords: Template, SOP, Protocol, Recipe, PPE, Storage, Procedure, Waste, Hazard, Safety, Storage, Spill Control, Experiment, Gel, Waste, Incompatibility

Please submit this to your EHS Coordinator and/or Lead Contact or send to

Please mark an ‘X’ in the gray boxes where appropriate to indicate selection.

Title
Author(s): / Date:
Revision #:
Reviewed by (Check all applicable): __CHO __ PI __ EHS / Name and Signature:
Type OF HAZARD:
Chemical Specific / Process/Equipment (primarily chemical hazard) / Process/ Equipment (primarily physical hazard) / Other
SCOPE AND APPLICABILITY
Department, Lab or Center:
Research Group:
Lab Bldg., Room(s):
Brief Description of Operation/Experiment , key hazards and summary of controls:
CHEMICAL HAZARDS
Principal Chemicals Used / Peroxide Former / Flammable / Corrosive / Sensitizer / Carcinogen / Teratogen;/Mutagen / Biological Toxin / Acutely Toxic / Pyrophoric / Water-Reactive / Shock Sensitive / Unstable / Penetrates Skin / Other Comments
Describe how and where SDS information for above chemicals is maintained in the lab (notebook or on computer or attached to this SOP)
Step by Step Hazard Analysis
Enumerate the steps to be followed in performing the procedure and the required precautions to avoid harm. The steps should be detailed and should include prohibited activities and cautionary statements, where applicable. Include in procedure waste management requirements.
Task / Hazards / Precautions
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Special PPE required is noted below. Note: Standard PPE, listed in Part II of the Department CHP should always be worn in the lab. The section below is for additional PPE required due to the unusual nature of materials involved. If no additional PPE is needed, this section can be deleted.
Goggles / Faceshield Safety Glasses
Protective Clothing, Special lab coat, chemical resistant apron, etc. (list type)
Other (list item or items)
Gloves (thickness, length, and whether disposable or reusable should also be considered in gloves selected.)
Butyl / Neoprene
Nitrile – double glove / Silver shield or 4H
PVC / Kevlar
Latex / Other (list)
Respirator (If checked, contact EHS Office for additional assistance, unless already in program)
SPECIAL PRECAUTIONS
Training:
Medical Surveillance:
Temperature/Pressure Sensitive:
Primary Containment (i.e. BSC, Fume Hood, Glove Box):
Other:
SPECIAL EMERGENCY PROCEDURES
This section is for any emergency procedures different from standard responses, or for additional emergency information due to the nature of materials or task.
Fire/Explosion:
Chemical Spill:
Personal exposure or other medical emergency:

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Definitions: BSC: Biosafety Cabinet

CHP: Chemical Hygiene Plan

CHO: Chemical Hygiene Officer

EHS: Environment, Health and Safety

PPE: Personal Protective Equipment

SDS: Safety Data Sheet

SOP: Standard Operating Procedure