Fillable Laboratory Risk Assessment Tool (Stanford University)

Fill Online, Printable, Fillable, Blank Laboratory Risk Assessment Tool (Stanford University) Form

Use Fill to complete blank online STANFORD UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Laboratory Risk Assessment Tool (Stanford University)

On average this form takes 39 minutes to complete

The Laboratory Risk Assessment Tool (Stanford University) form is 7 pages long and contains:

  • 1 signature
  • 180 check-boxes
  • 69 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Stanford University

BROWSE STANFORD UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1 LSP_17-109-v2021
Last update: 12/06/2021
Laboratory Risk Assessment Tool
The Stanford Laboratory Risk Assessment Tool provides a framework for risk
assessment that maps onto the scientific method, melding with the process
researchers already use to answer scientific questions.
This tool allows researchers to systematically identify and control
hazards to reduce risk of injuries and incidents. Conduct a risk
assessment prior to conducting an experiment for the first time.
The risk assessment process involves rating the risk of the
experiment, from “low” to “unacceptable” risk. Consult with your
PI/supervisor and EH&S if your risk rating is “high” or “unacceptable”
to redesign the experiment and/or implement additional controls to reduce
risk.
Procedure:
Lab Group:
Completed By: Date:
Identify your research question and approach. What question are you trying to answer? What
are you trying to measure or learn? What is your hypothesis? What approach or method will you use
to answer your question? Are there alternative approaches?
Research Question(s)
Approach(s) or Method
E
XPLORE
2 LSP_17-109-v2021
Last update: 12/06/2021
Identify the general hazards (check all that apply). Perform background research to identify known risks of the
reagents, reactions, or processes. Review protocols, Safety Data Sheets (SDSs), and safety information for hazardous
chemicals, agents, or processes. Review accident histories within your laboratory/department and Lessons Learned at
Stanford or other institutions.
Hazardous Agents
Physical Hazards of Chemicals
☐ Compressed gases
☐ Cryogens
☐ Explosives
☐ Flammables
☐ Organic peroxides
☐ Oxidizers
☐ Peroxide formers
☐ Pyrophorics
☐ Self-heating substances
☐ Self-reactive substances
☐ Substances which, in contact
with water, emit flammable
gases
Health Hazards of Chemicals
☐ Acute toxicity
☐ Carcinogens
☐ Eye damage/irritation
☐ Germ cell mutagens
☐ Nanomaterials
☐ Reproductive toxins
☐ Respiratory or skin
sensitization
☐ Simple asphyxiant
☐ Skin corrosion/irritation
☐ Specific target organ toxicity
☐ Hazards not otherwise
classified
Ionizing Radiation
☐ Irradiator
☐ Radionuclide
☐ Radionuclide sealed
source
☐ X-ray machine
Non-Ionizing Radiation
☐ Lasers, Class 3 or 4
☐ Lasers, Class 2
☐ Magnetic fields (e.g.,
NMR, MRI)
☐ RF/microwaves
☐ UV lamps
Biohazards
☐ BSL-2 Biological agents
☐ BSL-3 Biological agents
☐ Human cells, blood, BBP
☐ NHPs/cells/blood
☐ Non-exempt rDNA
☐ Animal field work
☐ High risk animals (RC1)
☐ Other (list):
Hazardous Conditions or Processes
Reaction Hazards
☐ Explosive
☐ Exothermic, with potential for fire,
excessive heat, or runaway reaction
☐ Endothermic, with potential for freezing
solvents decreased solubility or
heterogeneous mixtures
☐ Gases produced
☐ Hazardous reaction
intermediates/products
☐ Hazardous side reactions
☐ Generation of air contaminants
(gases, aerosols, or
particulates)
☐ Heating chemicals
☐ Large mass or volume
☐ Pressure > atmospheric
☐ Pressure < atmospheric
☐ Scale-up of reaction
Other Hazards
☐ Hand/power tools
☐ Moving equipment/parts
☐ Electrical
☐ Noise > 80 dBA
☐ Heat/hot surfaces
☐ Ergonomic hazards
☐ Needles/sharps
☐ Other (list):
General Hazards
Equipment Hazards
☐ Unguarded moving parts
☐ Cranes/lifts/hoists
☐ Ladders
☐ Energized equipment
☐ De-energized equipment
☐ High voltage (>50 volts)
☐ DC equipment (>800 Amperes)
☐ Maintenance/Modification of
electrical equipment
☐ Robotics
☐ Home-built equipment
☐ Soldering
☐ Lithium batteries
☐ Pressure or vacuum vessels
☐ Repetitive motion
☐ Contact stress
☐ Cold environment
☐ Awkward postures
☐ Lifting
>30 pounds
☐ Awkward lifts (e.g., poor grip,
long distance, uneven weight
distribution)
☐ Vibration
☐ Personal risk factors
☐ Strenuous physical activity
Site Hazards
☐ Confined spaces
☐ Slippery surfaces
☐ Working at elevated locations
☐ Oxygen deficiency potential
☐ Slip/trip/fall
Other Hazards
☐ Mental demands (e.g., long days, high
stress environment, language
barriers)
☐ Lack of experience
☐ Other (list):
3 LSP_17-109-v2021
Last update: 12/06/2021
Outline the Procedure. List the steps or tasks for your procedure and the hazard/potential
consequences of each. Include set-up and clean-up steps or tasks. Define the hazard controls to
minimize the risk of each step using the hierarchy of controls starting with the most effective (i.e.,
elimination, substitution, engineering controls, administrative controls, and personal protective equipment). List the
hazard control measure you would use for each step or task (e.g., run at a micro scale, work in a fume hood, wear face
shield and goggles).
A hierarchy of controls should be applied
starting with the most effective controls (i.e.,
elimination and substitution) at the top of the
graphic and moving down. While personal
protective equipment (PPE) should always be
used, it should be considered the last line of
defense from potential hazards.
1
For guidance on selection of Personal Protective
Equipment (PPE), use Stanford’s
Laboratory PPE
Assessment Tool.
2
For guidance on selection of chemical-resistant
gloves, see
Stanford’s Laboratory Chemical Glove
Selection Guide.
Field Hazards
*may also use sections above (as needed) for specific tasks/processes
Environmental Hazards
☐ Inclement weather
☐ Temperature extremes
☐ Sun exposure
☐ Darkness/low light
☐ Altitude
☐ Smoke/dust
☐ Fire
☐ Animals/insects
☐ Plants/allergens
☐ Hygiene/water-borne and
food-borne illness
☐ Vector-borne or other
endemic diseases (list):
Site Hazards
☐ Uneven/slippery surfaces
☐ Snow/ice
☐ Slide Hazards
(mudslide/avalanche)
☐ Heights/drop-offs
☐ Falling objects
☐ Tight spaces/overhangs
☐ Boating/swimming/water
hazards (waves, tides, current,
depth)
☐ Navigation challenges
☐ Limited communication
☐ Remote area/limited medical
services
Personal Security
☐ Crime/theft
☐ Risk of
harassment/violence
☐ US State Department
active travel alert
☐ Traveling alone
☐ Entering personal
residences
☐ Unfamiliar with area
(roads,
neighborhoods,
terrain, etc.)
☐ Unfamiliar with local
customs/cultural
norms
Task/Equipment Hazards
☐ Driving/vehicle
operation/traffic
☐ Drone use
☐ Lifting/carrying
☐ Digging/trenching
☐ Hand tools/power tools
☐ Sharp objects
☐ Loud noises
☐ Strenuous physical activity
☐ Mental demands (e.g., long
days, high stress
environment, language
barriers)
☐ Other (list):
P
LAN
4 LSP_17-109-v2021
Last update: 12/06/2021
Outline the Procedure.
Steps or Tasks Hazard Hazard Control Measure(s)
PLAN
5 LSP_17-109-v2021
Last update: 12/06/2021
Select the appropriate PPE and safety supplies for the procedure (check all that apply).
Laboratory PPE/Safety Supplies
☒
Appropriate street clothing (long pants, closed-toed shoes)
☐ Gloves; indicate type: ________________________
☐ Safety glasses
☐ Safety goggles
☐ Face shield and googles
☐ Lab coat
☐ Flame-resistant lab coat
☐ Other (list):
☐
Fire extinguisher
☐ Eyewash/safety shower
☐ First aid kit
☐ Spill kit
☐ Specialized medical supplies (e.g., calcium gluconate for
hydrofluoric acid)
General Safety Supplies
☒
Proper clothing (long pants, long sleeve shirt, warm layers,
rain/wind protection, sun protection, hat etc.)
☒ Proper footwear (list): _________________________
☒ Communication device
☐ Eye protection (safety glasses and/or sunglasses)
☐ Work gloves
☐ Hardhat
☐ Hearing protection
☐ First aid kit
☐ Map (and GPS)
☐
Sunscreen
☐ Anti-animal devices (e.g., bear bell, whistle, bear
canister)
☐ Personal floatation device
☐ Fall protection
☐ Road flares
☐ Safety vests
☐ Extra food, water/water treatment method
☐ Personal medications
☐ Other (list all):
Identify the appropriate training (check all that apply). Identify the general safety and procedure
based/specific training appropriate for your procedure.
General Safety
General Safety
☒ General Safety & Emergency Preparedness
(EHS-4200)
☐ Laboratory Ergonomics (EHS-4800)
☐ Confined Space Entry or Awareness (EHS-
2300 or EHS-2450)
☐ Electrical Safety Awareness (EHS-2800)
☐ Fire Extinguisher Use in Labs (EHS-3825)
Chemical Safety
☐ Chemical Safety for Laboratories (EHS-1900)
☐ Compressed Gas Safety (EHS-2200)
☐ Cryogenic Liquids and Dry Ice Safety
(EHS-2480):
Radiation Safety
☐ Radiation Safety and Radiation Safety
Hands-On (EHS-5250 and 5251)
☐ Radiation Safety SAIF (Small Animal Imaging
Facility) (EHS-5255)
☐ Sealed Sources, Non-Irradiator (EHS-5265)
☐ Research Cabinet X-ray or Irradiator (EHS-
1755) and Refresher (EHS-1756)
☐ Irradiator Security Training (EHS-4780) and
Refresher (EHS-4781)
☐ Laser Safety (EHS-4820) and Refresher
(EHS- 4821)
Biosafety
☐ Biosafety (EHS-1500)
☐ Bloodborne Pathogens (EHS-
1600) and Refresher (EHS-
1601)
Field Safety
☐ CPR
☐ Wilderness First Aid
☐ SCUBA certification/diving
safety
☐ Driving safety
☐ Other (list):
Procedure Based/Job Specific Training
☒
Lab/job-specific training
☐ Lab SOP(s) to review (list):
☐
Emergency plans or field evacuation plans
☐ Equipment SOP(s) to review (list):
☐
Other (list):
6 LSP_17-109-v2021
Last update: 12/06/2021
Question your methods. What have you missed and who can advise you? Challenge your hazard
control measures by asking “What if…?” questions. “What if” questions should challenge you to
find the gaps in your knowledge or logic. Factors to consider are human error, equipment failures, and deviations
from the planned/expected parameters (e.g., temperature, pressure, time, flow rate, and scale/concentration).
Assign a risk rating to the
experiment. Based on your
procedure outline and the what if
analysis, determine the risk rating
for the experiment or procedure.
Risk Rating: ___ __________
Revise plan if the risk rating is too high.
Are these risks acceptable? Use the table
below to determine the action to take
based on the risk rating. What are the
highest risk steps? What more can you do
to control the risks? Return to planning
and use the hierarchy of controls to design
a safer experiment.
PI/Supervisor Approval: ________________________________________________________
*Signature required for High risk ratings.
NOTE: Unacceptable risk rating experiments may not proceed. Introduce further controls to reduce risk.
What If Analysis
What if…? Examples: there is a loss of cooling? …valves/stopcocks are left open/closed? …there is unexpected over-pressurization?
…a spill occurs? …the laser is misaligned? …weather conditions change?
Then… …there may be a runaway reaction. …there may be an unexpected splash potential. …the reaction vessel may fail. …there
may be a dermal exposure. …there may be an eye injury. …routes may be inaccessible.
What if…?
Then…
What if…?
Then…
What if…?
Then…
Risk Rating Table
1
Severity of Consequences - Personnel Safety
No
Injuries
Minor
Moderate to
life impacting
Life threatening
from single
exposure
Likelihood of
Occurrence
(Almost) Certain Low High* Unacceptable* Unacceptable*
Likely Low Medium High* Unacceptable*
Possible Low Medium High* High*
Rare Low Low Medium High*
Risk Rating Action Table
Hazard Risk
Rating
Action
Unacceptable*
STOP! Additional controls needed to reduce risk. Consult
with PI and EH&S (650-723-0448).
High*
Additional controls recommended to reduce risk. Consult
with PI and EH&S (650-723-0448).
Medium
Ensure you are following best practices. Consult with peers,
PI, or EH&S, as needed.
Low
Perform work within controls.
1
The Risk Rating is subjective. The primary goal is for researchers to pause, think about risk, and differentiate
unacceptable and high-level risk steps from those with a lower level risk. This will help drive additional
consultation and control measures where needed.
CHALLENGE
click to sign
signature
click to edit
7 LSP_17-109-v2021
Last update: 12/06/2021
Perform a trial run. How you can test your experimental design? Can you do a dry run of the procedure
without hazardous chemicals/reagents/gases to familiarize yourself with equipment and demonstrate your ability
to manipulate the experimental apparatus? Can you run the procedure with a less hazardous material? Can you
test your experimental design at a smaller scale? If your procedure requires multiple people, would a table top
exercise be useful?
Trial Run
Trial Run Procedure:
Did the trial go as expected? Yes
☐
No
☐
Experimental design changes needed (if any):
Perform and evaluate. Run your procedure using the appropriate controls you’ve identified.
Evaluate controls and hazards as you work. Critique the controls and process you used by
answering the following questions. If changes to controls are needed, update your risk assessment tool and re-
evaluate any time you revise your process (e.g., changes in scale, reagent, equipment, or conditions that might
increase the hazard/risk). Share your assessment with your PI/colleagues for the next iteration of the experiment.
Evaluate Your Procedure
What went well?
Did the controls perform as expected?
Did anything unexpected occur?
Did a hazard manifest itself that was not previously identified?
Were there any close-calls or near misses that indicate areas of needed improvement?
Did something go exceptionally well that others could learn from?
I plan to evolve my procedure by...
A
SSESS
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Laboratory Risk Assessment Tool (Stanford University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 28 December 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document