University of Alabama

Declaration of Hazards Checklist

Research Faculty __________________________________________________________________

Dept ____________________    Building(s) _______________    Room(s) _____________________

Date of Completion ________________________________________________________________

Prepared by _____________________________________________________________________

Please put a check in the blanks below that correspond to potential hazards found in your lab or work area.  Then identify any more specific hazards, if so requested.  Several areas will require additional documentation to meet the regulatory requirements of various agencies.  If you have any questions about how to classify a particular hazard, or if you are unsure if a particular hazard applies to your area, please call EHS at 348-5905. 

A.  _____ Chemicals - the storage and/or use of chemicals requires that a Laboratory Chemical Hygiene Plan be completed and submitted to EHS.  The current version of the UA CHP is maintained on the EHS website, www.bama.ua.edu/~ehs.  You must also complete and submit a current Registration of Personnel .

Please indicate if you are exposed to any of the following chemical hazards:

B.  _____ Biological Agents - work with any biological material at any safety level must be registered with EHS.  Registration forms can be found here or on the EHS website, www.bama.ua.edu/~ehs.  Prior Approval from the Institutional Biological Safety Committee must be granted before you may work with:  any Select Agents, any agents at BSL 3 or higher, or do any recombinant DNA work.  You must also complete and submit a current Registration of Personnel .

Please indicate if you are working with any of the following:

C.  _____ Animals - all researchers on campus who plan to work with animals must submit a protocol for approval to the Institutional Animal Care and Use Committee (IACUC).  All University sponsored or sanctioned use of vertebrate animals requires IACUC approval.  Enter IACUC approved protocol number here: __________

Each area with houses or utilizes live animals for the purpose of research, study, academic instruction, or display is also required to have a written Animal Management Plan (AMP) on file with EHS.  A inventory of animals must be on file with EHS and updated every six months. 

D.  _____ Ionizing Radiation - the Radiation Control Advisory Committee must approve anyone who works with ionizing radioactive material or radiation producing instruments.  Enter sublicense number here: _________  Forms for approval can be found at http://bama.ua.edu/~ehs/New%20Web/radprog.htm.  You must also complete and submit a current Registration of Personnel .

E. _____ Lasers - all classes of lasers must be registered with EHS.  Work with lasers of Classes 3b and 4 require prior approval of the Laser Safety Committee before use.  Forms for registration and approval can be found at http://bama.ua.edu/~ehs/New%20Web/laseprog.htm.  You must also complete and submit a current Registration of Personnel .

Please indicate if you are working with any of the following:

F. _____ High Magnetic Fields - any instruments that generate high magnetic fields (greater than 17 Gauss) pose a potential hazard to anyone using a pacemaker.  EHS will need to investigate the site to determine the extent of the area affected.   _____ Check here if EHS has completed a magnetic field survey.

G. _____ Hazardous Equipment - this would include any instruments or equipment likely to cause serious physical injury or death to an individual through use or misuse.

H. _____ Potentially Sensitive Information - this would include any research areas included on the Technology Alert List, as well as any research areas with special security requirements imposed by the funding agency.  Details of this area are covered in the Research Security Evaluation.   You must also complete and submit a current Registration of Personnel .

I. _____ Environmental and Ecological Effects

J. ____ Atmospheric Hazards   

K.  ____ Construction or Transportation

L. ____ Worker Capability