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University of Washington Checklist for Compliance with the HazCom StandardsSupervisor:Date:School/Department:Organization/Lab/Shop/Office Name:Building:Room Number(s):Please check “YES,” “NO,” or “NOT APPLICABLE” for each item. Comments may be written next to the question or atthe end of the survey. Questions answered “NO” require corrective action.# Y N NQUESTION / RESOURCE FOR GUIDANCEAREGULATORYCITATIONHave chemicals stored or used in your work area been checked to identify WAC 296-800-1those which are hazardous? / Identifying Hazardous Chemicals17010An “office-like” work area may have consumer-type chemicals with no “hazardous” chemicals identified. If thisrepresents your work area, much of the remainder of the checklist does not need to be completed. However, you mustaddress assessing new tasks, training about the HazCom program, asbestos awareness and record-keeping.(Questions #22 – #27, and #48).234567891011Have hazardous chemicals been listed in MyChem or a local spreadsheet? /Tracking Hazardous ChemicalsIf a local spreadsheet is used, have procedures been set up with EH&S totransfer inventory information to MyChem? / Tracking Hazardous ChemicalsIf a local spreadsheet is used, is the information transferred to the MyChemsystem in accordance with a schedule set in coordination with EH&S? /Tracking Hazardous ChemicalsIs the list of chemicals / inventory in MyChem checked annually to makesure it is current? / Tracking Hazardous ChemicalsHas a system been set up for handling Material Safety Data Sheets(MSDSs) and Safety Data Sheets (SDSs) – either electronically or usingpaper copies – so that all employees have access to them when they are atwork? / MSDSs/SDSsCan all employees demonstrate that they can retrieve the MSDS/SDS forany chemical they may use? / MSDSs/SDSsIf paper MSDSs/SDSs are maintained, are they checked annually to ensurean MSDS is available for every hazardous chemical in the work area? /MSDSs/SDSsIf paper MSDSs/SDSs are maintained, are all MSDSs/SDSs more than 5years old checked to verify that they are current? / MSDSs/SDSsIf an MSDSs/SDSs was received in your work that was not in the MyChemsystem, was a copy sent to EH&S? / MSDSs/SDSsIf any chemicals were received that did not have a legible label in English,were they returned to the supplier? / Container LabelingWAC 296-800-17010, Local FireDepartment FireCode, 6 CFR Part27, 40 CFR Parts355 and 370Local FireDepartment FireCode, 6 CFR Part27, 40 CFR Parts355 and 370UW PolicyUW Policy,WAC 296-800-17010WAC 296-800-17020, WAC 296-828-20020WAC 296-800-17030, WAC 296-800-17035, WAC296-828-20020UW PolicyUW PolicyWAC 296-800-17015, WAC 296-828-20020WAC 296-800-17025

1213141516171819202122232425262728Are all containers holding chemicals labeled (if they are containerized forlonger than the shift in which they were generated)? / Container LabelingDo all container labels identify the chemical name and its hazards? /Container LabelingIs there an effective method of identifying the contents and hazards ofunusual containers, such as long runs of tubing, pipes, built-in containers,hidden reservoirs, etc. if those situations are present in the work area? /Container LabelingIf peroxide-forming chemicals are present in the work area, are thecontainers labeled with the UoW Form 1716 warning label? / ContainerLabelingIf chemicals are present in the work place which are on the list of chemicalsthat require notification to the Department of Homeland Security beforetransporting, are they labeled with the appropriate warning sticker? /Container LabelingAre NFPA 704 (diamond) signs posted at the doors of chemical laboratoriesand hazardous chemical storage rooms that require them? / ContainerLabelingHave all procedures involving chemicals which require use of personalprotective equipment (PPE) such as eye protection and gloves beenassessed and the PPE selected? / Documenting Safe ProceduresIf in a chemical laboratory, are the PPE requirements noted in the StandardOperating Procedures (SOPs)? / Documenting Safe ProceduresIf in any type of work area other than a chemical laboratory, are PPErequirements documented on one or more Job Safety Analyses or JobHazard Analyses (JSAs/JHAs)? / Documenting Safe ProceduresDo all JHAs requiring PPE have the statement: “This document is thecertification of hazard assessment for PPE for the workplace.”? /Documenting Safe ProceduresAre personnel aware of the need to assess new or unusual tasks forhazards and to document the procedures and PPE appropriately? /Documenting Safe ProceduresHave all work area employees completed general awareness training withinthe last 12 months concerning asbestos in UW facilities? / Chemical SafetyTrainingIs there a copy of the poster “UW Chemical Hazard CommunicationProgram” on the work area’s/department’s safety bulletin board? / HazComTrainingHave all employees been told about the UW HazCom program and beenshown or been told about the UW HazCom poster? / HazCom TrainingIf the employees’ only exposure to hazardous chemicals is minimal use ofconsumer products such as a marker pen, did the employees receive thebrochure about office chemicals prior to using such items at the UW? /HazCom TrainingIf employees use consumer goods such as furniture polish, marking pens,etc. more than a consumer may use them, have the consumer goods beenincluded in the HazCom program and the employees trained? / HazComTrainingIf employees are or may be exposed to hazardous chemicals, have theyreceived effective training before the time of their first exposure? / HazComTrainingWAC 296-800-17025WAC 296-800-17025WAC 296-800-17025UW PolicyUW PolicyLocal FireDepartment FireCodeWAC 296-800-16005, WAC 296-828-20005WAC 296-828-20005WAC 296-800-16010WAC 296-800-16010WAC 296-800-17005, WAC 296-828-20015WAC 296-62-07722,Washington StateLabor and IndustriesCitation and Noticeof AssessmentInspection#306648205UW APS 10.3.3UW APS 10.3.3,WAC 296-800-17030UW PolicyWAC 296-800-170WAC 296-800-14005, WAC 296-800-14020, WAC296-800-17030,WAC 296-800-17035, WAC 296-828-20015

29303132333435363738394041424344Have all employees potentially exposed to hazardous materials beentrained to the point that they can identify which chemicals are hazardous? /HazCom TrainingHave all employees potentially exposed to hazardous materials generatedby work area processes (but not on the hazardous chemical inventory) beentrained to the point that they can identify those processes and exposuresituations? / HazCom TrainingHave all employees potentially exposed to hazardous materials beentrained as to methods and observations for detecting the release of thehazardous substances? / HazCom TrainingHave all employees potentially exposed to hazardous materials beentrained as to what are the physical and health hazards of the chemicals andprocesses in the work area? / HazCom TrainingHave all employees potentially exposed to hazardous materials beentrained as to the equipment, procedures and PPE to be used to protect fromchemical exposures? / HazCom TrainingHave all employees using or being exposed to hazardous materials beeninformed about the signs and symptoms of health effects which might arisefrom exposure to the work area chemicals? / HazCom TrainingHave all employees exposed to a hazardous chemical been informed thatthey can get a medical consultation at a UW Employee Health Clinic if theythink the exposure may have caused some health effect? / HazComTrainingIf in a chemical laboratory, have employees been trained about WAC 296-828, the use of the lab’s Chemical Hygiene Plan including SOPs to describesafe procedures, the exposure limits for the chemicals in use, and wherethis information and other references can be found? / HazCom TrainingIn other work areas (not chemical laboratories), have employees beentrained about the HazCom requirements found in APS 12.5 and WAC 296-800-170 and where these references can be found? / HazCom TrainingHave employees been informed annually that EH&S maintains monitoringrecords and can help interpret results and applicable regulations and thatthey have a right to access these monitoring records? / HazCom TrainingIf the department or work unit maintains records of exposure monitoring, areemployees informed annually that they have a right to access thosemonitoring records? / HazCom TrainingHave employees been informed annually that they have a right to accesstheir medical records? / HazCom TrainingIf personnel are exposed above a permissible exposure limit or action level,are they informed annually of the chemical’s hazards and their requiredprotective measures? / HazCom TrainingIf use of PPE is required, have employees been trained to the point thatthey can demonstrate proficiency in selecting, donning, doffing, anddisposing or maintaining the PPE and they know of any limitations in use? /HazCom TrainingIf PPE is required in order to enter a work area, even though those peopleare not expected to have any chemical exposure, have those employeesbeen trained in proper donning, doffing and disposal procedures and theirresponse in case of emergency? / HazCom TrainingIf chemicals are simply stored in an area without being used or dispensedfrom bulk containers, have employees been trained in recognizing anemergency situation (i.e., spill), what the hazards may be, and how torespond? / HazCom TrainingWAC 296-800-17030, WAC 296-800-17035, WAC296-828-20015WAC 296-800-17030, WAC 296-800-17035, WAC296-828-20025WAC 296-800-17030, WAC 296-800-17035, WAC296-828-20015WAC 296-800-17030, WAC 296-800-17035, WAC296-828-20015WAC 296-800-17030, WAC 296-800-17035, WAC296-828-20015WAC 296-800-17030, WAC 296-800-17035, WAC296-828-20015WAC 296-800-17030, WAC 296-828-20030WAC 296-828-20015WAC 296-800-17030WAC 296-800-18010, WAC 296-802-30005WAC 296-802-30005WAC 296-802-30005Chemical-specificWACWAC 296-800-16025, WAC 296-828-20015UW PolicyWAC 296-800-17040

45464748495051Comments:If chemicals are received with labels or the Safety Data Sheet supplied inaccordance with the GHS (Globally Harmonized System for Classifying andLabelling), have employees handling and using the chemicals been trainedas to the meaning of the labels and warnings? / HazCom TrainingIf an employee handling and using hazardous chemicals appears to havemisunderstood the hazards or required protective measures in any way,was refresher training given and documented? / HazCom TrainingIf a new chemical or process with a new hazard has been introduced intothe work area, were employees trained prior to their first exposure? /HazCom TrainingHas employee chemical safety training addressing the above areas beendocumented? / HazCom TrainingIf a hazardous chemical is produced by the UW and sent to a non-UWrecipient, has an MSDS/SDS and label been generated in accordance withapproved procedures? / Providing an MSDS/SDS and Label for a UW-Synthesized ChemicalIf you hire a contractor who may bring hazardous chemicals or hazardousprocesses on to the UW which may expose UW personnel to hazardousexposures, have you informed the contractor that they must inform you ofthe hazards and take steps to control the exposures to the UW personnel? /HazCom Involving ContractorsIf you hire a contractor to do work that may expose the contractor’spersonnel to hazardous exposures from UW operations, did you inform thecontractor of the potential hazardous exposures and take steps to controlthe exposures? / HazCom Involving ContractorsUW PolicyWAC 296-828-20015WAC 296-800-17030, WAC 296-828-20015UW PolicyWAC 296-800-17035, WAC 296-828-20025, WAC296-839WAC 296-800-17007WAC 296-800-17007Corrective Action Items:Review Conducted By: (Print)PI / Supervisor / Manager Signature:Date: