Gas Detection and Local Ventilation System Survey

PI Name*

Department*

Safety Representative*

Lab Location*

EH&S would like to identify locations of all gas detection and local ventilation systems in order to monitor proper maintenance and services. In an effort to improve our collaborations and develop tools and procedures to enhance the safety culture, prevent and mitigate potential hazards, and address safety challenges regarding Engineering Controls, EH&S would appreciate your response to the following questions.

DOES YOUR LAB HAVE A GAS DETECTION SYSTEM?*

Yes

No

If yes:

What is the purpose of the system?

Flammable/Fuel Gas

Oxygen Level

Toxic Gas

What is the make/model/manufacturer?

What is the frequency of calibration?

What is the date of last calibration?

Are alarms audible and/or visible?

Audible

Visible

Both

Are alarms fixed or portable?

Fixed

Portable

How many gas sensors exist in the lab?

Are gas detection system users trained?

Yes

No

List all users' names and date of training.

DOES YOUR LAB HAVE A DUCTLESS FUME HOOD?*

Yes

No

If yes:

What is the make/model/manufacturer?

Briefly describe the operation the fume hood is used for.

IS THERE LOCAL VENTILATION PRESENT IN THE LAB?

Select or enter value

If yes:

Select the type of local ventilation.*

Select

Is it connected to a piece of equipment? if yes, provide make/model/manufacturer of equipment.

Briefly explain the operation/process that the local ventilation is used for.

Is it sufficient for your purpose? If not, please comment.

Is it shared? If yes, indicate the name of pis/users.

ARE THERE GAS CABINETS IN THE LAB?

Yes

No

If yes:

How many gas cabinets?

Indicate model(s)/manufacturer(s).

Is there an associated gas monitor?

Yes

No

Is there an associated airflow monitor?

Yes

No

Attach images of the systems/equipment described above.

Drag and drop files here or

Send me a copy of my responses

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