Fillable Laboratory Worker Safety: Training Needs Assessment And Documentation printable pdf download

UCSB Environmental Health & Safety

Revised 9/2013

LABORATORY WORKER SAFETY:

TRAINING NEEDS ASSESSMENT and DOCUMENTATION

(completion and filing of this form for each supervisee is the responsibility of the laboratory supervisor)

Instructions: under CA law and UC policy, lab supervisors are responsible for ensuring that their workers have received

documented safety training. Particularly, for: new employees; employees given new job assignments for which documented training

has not previously been received; whenever new hazards are introduced, or recognized. Training can be formal or informal, and

individual or group-based. This form serves two purposes relative to the above requirements:

1. A place to complete a “Training Needs Assessment” for each supervisee to first identify what training is appropriate for that

individual. A formal assessment is required per the 2013

UC policy: Laboratory Safety Training

2. A place to document the training as it is completed.

Laboratory Worker Name: _____________________

Supervisor Name: _______________________________

1. On-Site Laboratory Safety Orientation (“day-one orientation”, per UC policy)

A. Emergency Procedures

Topic Covered

Training Topic



UCSB Emergency Information Flipchart: location/purpose – posted in every lab



Fire alarm pull station: Location of and how to activate



Emergency eyewash/shower: Location of and how to activate



First aid Kits: Locations of and contents



Building Emergency Assembly Point and routes of exit – see last pg. of Flipchart



UCSB Alert System (optional emergency texting system): purpose and enrollment process

B. Engineering Controls



NA:

Chemical fume hoods: Demo proper use and instruct on alarms/controls



NA:

Biological safety cabinets: Demo proper use and instruct on alarms/controls



NA:

Chemical storage: Locations of and segregation rules



NA:

Other engineering controls: glove boxes, gas cabinets, etc. – demo proper use

Describe:

C. Administrative Controls



NA:

Laboratory Safety Manual and Chemical Hygiene Plan: location & contents. See also pg. 3: Chemical Hazards.



NA:

(Material) Safety Data Sheets: Demo electronic or hard copy access to repository

D. Personal Protective Equipment



NA:

Lab coat and Eye protection: UC provided/fitted starting 2/14. Proper PPE will be determined and authorized via

online Laboratory Hazard Assessment Tool (LHAT)



NA:

Prescription safety glasses provided: Via optometrist (over-the-glasses goggles are another option)



NA:

Gloves: Provided by lab. Location of, knowledge to select correct type and how to properly don/doff.



NA:

Other PPE: Lab provided. Describe:

E. Waste Disposal



NA:

Chemical/Biological/Radiological/Sharps Disposal: Demo labeling/storage/pickup

F. Other



NA:

Describe:

Lab worker acknowledgement: I have been trained on, or provided with, all the above that are applicable to my work.

Lab worker signature: _____________________________

Date:_________________

Supervisor, or designated trainer signature: ______________________

Date:_________________

Laboratory Worker Safety: Training Needs Assessment And Documentation

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