Chemical Storage Safety Assessment Survey Form
Assess chemical storage safety practices, identify hazards, and record recommended follow-up actions.
Facility and Storage Context
Facility/Site Name
*
Storage Area / Location Identifier
*
Primary Chemical Storage Purpose / Operation Type
*
Laboratory
Warehouse
Production
Maintenance
Other
Approximate Number of Chemical Storage Locations / Rooms
*
Storage Safety Assessment
Container labeling
*
Non-compliant
1
2
3
4
Fully compliant
5
1 is Non-compliant, 5 is Fully compliant
Segregation of incompatible chemicals
*
Non-compliant
1
2
3
4
Fully compliant
5
1 is Non-compliant, 5 is Fully compliant
Secondary containment
*
Non-compliant
1
2
3
4
Fully compliant
5
1 is Non-compliant, 5 is Fully compliant
Ventilation adequacy
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Shelving/racking condition
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Spill kit availability
*
Not available
1
2
3
4
Fully available
5
1 is Not available, 5 is Fully available
Emergency eyewash/shower access
*
Not accessible
1
2
3
4
Fully accessible
5
1 is Not accessible, 5 is Fully accessible
Aisle/egress clearance
*
Blocked
1
2
3
4
Clear
5
1 is Blocked, 5 is Clear
Hazards and Incident Review
Main safety concern or hazard observed
*
Any spills, leaks, or near-misses reported?
*
Yes
No
If yes, describe the most recent incident and corrective action taken
Overall Risk and Follow-up
Overall storage safety rating
*
1
2
3
4
5
Follow-up priority
*
Low
Medium
High
Urgent
Recommended actions or improvements
Submit Assessment
Should be Empty: