Experimental Review and Process Safety Form

    Personal Information

    Experiment Information

    Experiment Run Time
    ContinuousLimited Time

    Design Specifications:

    Emergency Shutdown Procedure:

    Chemical Hazards

    Select Chemical Hazards:
    FlammableToxicReactivePyrophoric or Water-ReactiveEnvironmental hazardCorrosiveIrritant

    Potential Routes of Exposure:

    Engineering Controls:
    Chemical fume hoodSnorkelGloveboxOther

    Special Handling, Transferring, and Storage Requirements:

    Physical Hazards

    Select Physical Hazards:
    ElectricalNoise (please specify source below)Gas cylindersTemperature (please specify below)PressureVacuumGas flow (please specify pressure below)Vibration (please specify source below)Machine/moving parts (please specify below)High voltageExposed wiringHigh currentHome-built electrical components

    System Design:
    Open systemClosed system
    If closed, is there a pressure relief valve?

    Personal Protective Equipment

    Protective Clothing:
    Lab coat (please specify type below)Chemical-resistant apronArm sleeves

    Eye and Face Protection:
    Safety gogglesSafety glassesFace shield

    Hand Protection:
    Disposable gloves (please specify type below)Reusable gloves (please specify type below)Work glovesCryo glovesCut-resistant gloves

    Hearing Protection:
    Ear plugsEar muffsEnrolled in the EHS Hearing Conservation Program

    Respiratory Protection:
    Air-purifying respirator (please specify type below)Atmosphere-supplying respirator (please specify type below)Enrolled in the EHS Respiratory Protection Program

    Head Protection:
    Hard hat type IHard hat type IIBump cap

    Protective Footwear:
    Metatarsal guardsToe guardsSafety shoesElectrically conductive shoesNon-conductive shoes

    Chemical, Biological, Radiological Waste Disposal Practices:

    Safety Resources: