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University of California, Berkeley
2007-08 Laboratory and Shop Self-Inspection Program Summary Form



Please use this form to summarize the results of your department’s Laboratory and/or Shop Self-Inspections. Then mail this form and a complete set of your department’s Laboratory and/or Shop Self-Inspection Forms, to the following address by November 16, 2007:

Office of Environment, Health & Safety
317 University Hall
MC 1150



Please note that copies of the completed Laboratory and Shop Self-Inspection Forms must be retained within the department so that they will be available in the event of a Cal/OSHA inspection. Also, please share the information contained on this Summary Form at your next departmental safety committee meeting.
Department:___________________________________________________________ Date:_______________________
Department Safety Coordinator (DSC):______________________________________  
Phone Number:_________________________________________________________  

1.

How many laboratories are in your department? _________________________________
2. How many of these laboratories were inspected?_________________________________
  • If any laboratories were not inspected, what was the reason for this?

 

 
3. How many shops are in your department?______________________________________
4.

How many of these shops were inspected?

  • If any shops were not inspected, please explain.

 

 
 
  • Which items were the most difficult to correct? Why?

 

 
5.

Which self-inspection form(s) did your department use?

______The Laboratory/Shop Self-Inspection form as provided by EH&S

______A modification of the EH&S-provided form

______A department-generated form

6.

In your review of the completed self-inspection forms, what did you find to be the major trends?

  • Please list the most common items needing correction:




  • Which items were the most difficult to correct? Why?

 

 
7.

Have all identified deficiencies now been corrected? If not, when do you estimate the corrective actions will be complete?

 

 
8.

If you used the EH&S Laboratory Self-Inspection Form, please describe any specific changes you would like made to the form.

 

 
9.

Please describe any specific changes you would like to see in the overall laboratory self-inspection process (e.g., different time of year, different routing).

 

 

 

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