Laboratory Inspection Form
Laboratory Number
Gas Responsible Person
First Name
Last Name
Laboratory Responsible Person
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
Handover of Lab To Gas Personnel
*
Rows
Yes
No
Notes
Confirm all equipment/instrumentation has been removed from work area where possible?
2
3
Confirm equipment/instrumentation that cannot be moved has been suitably protected?
4
5
Confirm tables/desks/work area has been suitably protected with the use of protective foam wrap?
6
7
Confirm gas has been informed of any highly sensitive equipment that cannot be removed?
8
9
Take Photo
Take Photo
Take Photo
Take Photo
Lab Handover Safety Induction
*
Rows
Yes
No
Notes
Confirm all hazardous substances have been removed from the work area. (includes toxic, corrosive, flammable,
biohazard),
10
11
Confirm that hazardous substances that cannot be moved are safely stored and gas personnel have been inducted to work safely around these hazards?
12
13
Confirm that gas has been notified of any specific risks associated with working in the laboratory?
14
15
Confirm gas has been allocated a specific electrical circuit to make use of? (note: this may trip while work is being conducted)
16
17
Take Photo
Take Photo
Take Photo
Take Photo
Please note any damaged equipment/surfaces present before taking occupation
Take Photo of damaged
Take Photo of damaged
Take Photo of damaged
Take Photo of damaged
Additional Notes
Signature Gas Responsible Person
Signature Laboratory Responsible Person
Submit
Submit
Should be Empty: