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.

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

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.

Product	Pre-lab	Lab	Post-lab

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