Lab Standard/Hazard Communication Form

Completion of this form certifies that the signee has received OSHA-mandated Lab Standard/Hazard Communication training. Please check the box that you have received training on the element of the Lab Standard and understand your responsibilities as an employee. A copy of this will be sent to yourself, the chemistry office, and your supervisor.

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Name *

Date *

Email *

Supervisor *

Supervisor Email *

1. Lab Standard: Know the contents of the lab standard and appendices, and the location of a copy. *

I have received training

2. Chemical Hygiene Plan: Know the location and availability of the department chemical hygiene plan. *

I have received training

3. Exposure Limits: Know where to find permissible exposure limits for MIOSHA regulated substances and the recommended exposure limits for other chemicals used. *

I have received training

4. Exposure symptoms: Recognize signs and symptoms of exposure to chemicals in use in the lab(s). *

I have received training

5. Reference materials: Know the location and availability of known reference material on the hazards, safe handling and storage, and disposal of chemicals in the lab(s), including SDS, Michigan Tech’s hazard communication plan, and the department chemical inventory. *

I have received training

6. Detection of chemicals: Understand the methods and observations that may be used to detect the presence or release of the chemicals present in the lab(s) such as employer monitoring, continuous monitoring devices that have been installed, and visual appearance and odor. *

I have received training

7. Physical and health hazards: Know the physical and health hazards of chemicals in the lab(s) and other departmental areas. *

I have received training

8. Protective measures: Recognize measures that can be taken to protect against the above hazards including specific measures that have been implemented such as work procedures, emergency procedures, and personal protective equipment. *

I have received training

9. Chemistry Department CHP: Understand the applicable details of the department chemical hygiene plan (which includes lab-specific SOPs and the appropriate labeling system for chemical reagents). *

I have received training

By submitting this form you hereby certify that you have received OSHA-mandated Lab Standard/Hazard Communication training and understand your responsibilities as an employee.