Work Space Information
The information collected below will be used to produce a Safety Sign to be placed on both the inside and outside of the door leading to your lab or other research area.  The purpose of the sign is to provide users accessing the space current information regarding the hazards associated with the work, equipment and processes taking place inside the space.  The primary importance of the information collected and the forthcoming sign is to help in preventing injury and ensure faculty, staff, students and visitors are advised of the possible dangers and hazards in certain situations within the space.

It is expected the time needed to complete the survey is approximately 30 minutes. To fully complete the survey, you will need the following:

- Primary and Alternate Contact Information
- Safety Equipment Locations (e.g. first aid kit, fire extinguisher, SDS information, spill kit)
- Personal Protective Equipment (PPE) Requirements to Enter the Space
- Bio Safety Level & Risk Group Info (if applicable)
- National Fire Prevention Association (NFPA) Rating (if known)
- Hazard Communication Standard identifier (can be found on the Safety Data Sheet)
- Identify Other Safety Consideration (e.g. laser, high voltage, strong magnetic fields, simple asphyxiants)
- Radioactive Exposure Levels (if applicable)

If you have questions regarding how best to assess the hazards and information needed to complete the survey you may reach out to your department lab manager/technician or Penny Manisco, Chemical Hygiene Officer, HMC. A sample of what the completed sign will look like is below for reference.
Email *
Sample Sign
Work Space Name
Lab, Clinic, Shop, Maker Space, etc.  (Please be specific e.g. Cellular/Molecular Biology Lab.)
Department *
Chemistry, Physics, Engineering, etc.  (Please be specific.)
Building *
Jacobs, Keck, Olin, Parsons, etc. (Please be specific.)
Room Number *
SB12, B150, 1220, 2340 etc. (Please be specific.)
Primary Contact *
Format: [Full Name] and [Phone Number] Be sure to include both name and phone number. This name and phone number will be printed on the sign therefore making it visible to all who pass by the sign.
Alternate Contact
Format: [Full Name] and [Phone Number] Be sure to include both name and phone number. This name and phone number will be printed on the sign therefore making it visible to all who pass by the sign.
Second Alternate
Format: [Full Name] and [Phone Number]  Be sure to include both name and phone number.  This name and phone number will be printed on the sign therefore making it visible to all who pass by the sign.
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