Laboratory Contacts and Hazards Worksheet:

ROOM NUMBER _______________

• Principal Investigator: _________________________________
• In case of an emergency contact the following:
  
  Name ______________________________ Phone: _______________________
  Name ______________________________ Phone: _______________________
  Name ______________________________ Phone: _______________________
  
• Hazards present in this laboratory - provide approximate volumes for chemicals (check all that apply):
  
  

  ______High Voltage	______Radiation
  ______Flammable Chemicals	______Extremely Toxic Chemicals
  ______Carcinogenic Chemicals	______Cryogenics
  ______Water Reactive Chemicals	______Other (please list):

  
  
  
• In your opinion, if there were a fire in this lab, what would you consider to be the greatest danger to emergency responders?
  
  
  
• In the event of a general evacuation, would it be necessary for someone in your laboratory to delay evacuation in order to shut down instruments and/or experiments? Who would have this responsibility and what is the maximum amount of time it would take to complete the shut down procedures?
  
  
  
• On the following page, please sketch the layout of your laboratory, indicating the exits, fume hoods, lab benches and chemical storage areas, specifically water reactives, flammables and extreme toxics. Be sure to include any cut-off or inside storage rooms in your sketch. Review annually.

LAYOUT OF LABORATORY