Toxic Gas Purchase Questionnaire

Toxic Gas Purchase Questionnaire

Purpose and Instructions

Purpose: The purpose of this questionnaire is to provide EH&S with information on control measures in place for toxic gases prior to purchase and to ensure compliance with the Santa Clara County Toxic Gas Ordinance (TGO). Instructions: 1. Complete this questionnaire prior to each purchase of a toxic gas. 2. EH&S will review the questionnaire and contact you to approve the purchase or obtain more information. If you have any questions, please send an email to toxicgases@lists.stanford.edu or contact the Laboratory Safety program at 723-0448. Information on the TGO, including a toxic gas table, is available at https://ehs.stanford.edu/topic/hazardous-materials/toxic-gas

Purchaser Information

PI/Lab Supervisor Name*

PI/Lab Supervisor Email*

Stanford SUNet email only, no email alias

PI/Lab Supervisor Phone*

Name of Person Placing Order*

Email of Person Placing Order*

Stanford SUNet email only, no email alias

Phone of Person Placing Order*

Department*

School*

Select

Toxic Gas to be Purchased

Toxic Gas*

Select

If Other, specify:*

Percentage of components

Provide each gas (abbreviation okay) and percentage in the mixture, including diluent

Quantity*

Lbs and/or cubic feet at normal temperature and pressure

Storage and Use Locations*

Select or enter value

Use Location--Building*

Select

Use Location--Room*

Storage Location--Building*

Select

Storage Location--Room*

Standard Operating Procedure (SOP) for Toxic Gas Use

SOP submitted/reviewed by EH&S*

An SOP template for toxic gases is available at https://ehs.stanford.edu/wp-content/uploads/sops/SOP-template-toxic-gases.docx. If an SOP has not previously been submitted to EH&S, use this form (https://app.smartsheet.com/b/form/6af14bd85ac64e2b90ddd7f16ee91fdb ) to submit one. An SOP is required for work with Toxic Gases.

Select

PI/Supervisor has approved the SOP*

The PI/Supervisor must approve the SOP in writing. If it has not been approved in writing, do not select "yes".

Select

SOP Title*

SOP Date (month/year)*

User training has been/will be completed*

Confirm users of the toxic gas(es) associated with this order will complete or have completed compressed gas safety training (EHS-2200 or 4875) and all other safety training listed in the SOP prior to working with the toxic gas.

Select

Inventory

First time use for procedure/experiment*

Is this the first time this gas is being used for this procedure/experiment?

Select

Gas currently in inventory*

Will the cylinder being ordered increase your current inventory of this gas? EH&S must determine if the quantity of gas being purchased will exceed control area limits.

Select

Purchase quantity is 6-month supply or less*

This is a good practice so as to minimize the quantity of hazardous materials in the lab

Select

Lowest concentration possible*

Is the gas being purchased in the lowest concentration possible for the intended use?

Select

Control Measures

Restrictive flow orifice installed on cylinder*

Will the gas be purchased with a restrictive flow orifice (RFO) installed in cylinder? Per the TGO, all cylinders of Class I toxic gases, except lecture bottles and materials having a vapor pressure that does not exceed 29 psia, must be equipped with an RFO, if available. This includes cylinders of exempt quantities. If an RFO is not available, the cylinder must be used with a flow-limiting device. RFOs are recommended by EH&S for all toxic gas use. More information on RFOs is available at: • http://www.mathesongas.com/pdfs/products/Restrictive-Flow-Orifices.pdf • http://www.airproducts.com/company/Sustainability/environment-health-and-safety/~/media/Files/PDF/company/safetygram-46.pdf

Select

Equipment compatability*

Are the piping, fittings, and equipment compatible with the gas and able to withstand the temperatures and pressures of the procedure?

Select

Secured cylinders

Are there anchored racks or other measures in place for securing cylinders?

Select

Located within a laboratory fume hood*

Are the gas cylinder, piping, and equipment using the gas all located within a laboratory fume hood? This is requested for informational purposes. This control measure is appropriate for some uses.

Select

Hazardous Waste Minimization

Returnable cylinder*

Is the gas being purchased in a returnable cylinder? Check with the vendor.

Select

Anticipated Vendor*

Catalog #*

Additional Comments

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