# EBAA-E - Chemical Hazards Preparation Form

Lesson: _____________________________________________________________________

Date(s):_______________________

Chemicals identified to be use:

Name							Compatible with other chemicals?

_____________________________					___ Yes	___ No

_____________________________					___ Yes	___ No

_____________________________					___ Yes	___ No

Replacement of incompatible or high hazard chemicals evaluated? 	___ Yes	___ No

Check the row(s) below and columns(s) to the right indicating what safety equipment and procedures are to be used, and when they should be followed.


<table>
  <tr>
   <td>
   </td>
   <td>Pre-lab
   </td>
   <td>Lab
   </td>
   <td>Post-lab
   </td>
  </tr>
  <tr>
   <td>Corrosive Solid
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Corrosive Liquid
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Volatile
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Other
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Safety Glasses
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Goggles
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Splash Shield
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Gloves (list types available)
   </td>
   <td>(ID glove)
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Body Protection: Apron, lab coat
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>Foot: In addition to covered foot/toe areas
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
</table>


Respiratory, for those in the program:

 1. ❏	(list what’s available; splash guard, etc)  
 2. ❏	Use Fume Hood  
 3. ❏	Eyewash Station in working order  
 4. ❏	Safety Deluge Shower in working order  	
 5. ❏	Type of Fire Extinguishers required  

List any hazardous products, by products or wastes that may be created anytime during the use of the chemical identified above. Use diluted or small quantities of hazards. *Handle and dispose of properly.


<table>
  <tr>
   <td>Product
   </td>
   <td>Pre-lab
   </td>
   <td>Lab
   </td>
   <td>Post-lab
   </td>
  </tr>
  <tr>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
  <tr>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
   <td>
   </td>
  </tr>
</table>


Specific emergency procedures: [especially important for chemicals that are incompatible with usual spill kit or fire extinguishing materials.]