Biosafety Risk Assessment Checklist Form
Complete this checklist to assess biosafety risks in laboratory or controlled environments.
Work Area or Activity Being Assessed
*
Assessor Name
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Biological Material or Task
*
Please Select
Bacteria
Virus
Fungi
Human/Animal Samples
Cell Culture
Other
Biosafety Level
*
BSL-1
BSL-2
BSL-3
BSL-4
Key Exposure and Risk Factors
*
Rows
Not Present
Present
Aerosol Generation
1
2
Sharps Use
3
4
Surface Contamination
5
6
High Volume/Concentration
7
8
Personal Protective Equipment (PPE) Availability and Use
*
Rows
Available & Used
Available, Not Used
Not Available
Lab Coat
9
10
11
Gloves
12
13
14
Eye Protection
15
16
17
Respiratory Protection
18
19
20
Engineering Controls in Place
*
Biosafety Cabinet
Autoclave
Handwashing Station
Sharps Disposal
Other
Training and Competency Status
*
All Personnel Trained
Some Personnel Trained
No Training Completed
Incident History (Past 12 Months)
*
No Incidents
Minor Incidents
Major Incident(s)
Overall Risk Rating
*
1
2
3
4
5
Required Corrective Actions or Recommendations
*
Submit Assessment
Should be Empty: