F-QM-SAF-001-B-V0 — Safety Inspection Checklist, Emergency Drill & Safety Training Record
Type: Form · Version: V0 · Status: DRAFT — UNAPPROVED · Served read-only from the bundled QMS copies. The Drive master is untouched.
Parent document: LAB-QM-SAF-001 — Laboratory Safety Policy (parent is encoded in the form number)
Rendered in-browser from the project's Word file F-QM-SAF-001-B-V0-safety-inspection-and-drill-record.docx (policies-docx / forms-docx — the file Junry reviews). Formatting is faithful, not pixel-perfect; the DOCX is the official copy.
| Document # | F-QM-SAF-001-B-V0 | Parent Document | LAB-QM-SAF-001 — Laboratory Safety Policy |
|---|
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Part 1 — Semi-Annual Laboratory Safety Inspection Checklist
| Inspection Period: | [ ] Semi-Annual 1 (Jan–Jun) [ ] Semi-Annual 2 (Jul–Dec) | Date of Inspection: | YYYY-MM-DD |
|---|---|---|---|
| Lead Inspector: | ____________________________________, RMT | Safety Officer: | ____________________________________ |
| Safety Category & Item | Status (Compliant / Non-Compliant / NA) | Observations / Specific Defects Noted |
|---|---|---|
| 1. Work Practices & Personal Protection | ||
| Laboratory coats and gloves worn in testing areas; removed prior to leaving | [ ] Compliant [ ] Non-Compliant | |
| No food, beverages, chewing gum, smoking, or cosmetics in laboratory | [ ] Compliant [ ] Non-Compliant | |
| Workstations clean, organized, and uncluttered | [ ] Compliant [ ] Non-Compliant | |
| 2. Specimen Handling & Centrifugation | ||
| Mechanical pipetting devices used; mouth pipetting strictly prohibited | [ ] Compliant [ ] Non-Compliant | |
| Gauze/shield used when uncapping vacutainer tubes | [ ] Compliant [ ] Non-Compliant | |
| Centrifuge buckets balanced; lids locked during operation | [ ] Compliant [ ] Non-Compliant | |
| 3. Sharps Safety | ||
| Needles discarded unrecapped immediately into rigid sharps containers | [ ] Compliant [ ] Non-Compliant | |
| Sharps containers replaced and locked upon reaching 3/4 full mark | [ ] Compliant [ ] Non-Compliant | |
| Broken glass disposed of strictly in dedicated rigid glass bins | [ ] Compliant [ ] Non-Compliant | |
| 4. Chemical Hygiene & SDS | ||
| Chemical inventory verified against stock within the last 12 months | [ ] Compliant [ ] Non-Compliant | |
| Yellow SDS master binder complete, accessible, and current at entry | [ ] Compliant [ ] Non-Compliant | |
| Incompatible chemicals separated; flammable reagents stored away from heat | [ ] Compliant [ ] Non-Compliant | |
| 5. Emergency Facilities & Fire Safety | ||
| Emergency eyewash station unobstructed and flushed weekly | [ ] Compliant [ ] Non-Compliant | |
| Fire extinguisher inspected, pressure gauge in green, tag current | [ ] Compliant [ ] Non-Compliant | |
| Evacuation pathways and main entrance doors clear and unobstructed | [ ] Compliant [ ] Non-Compliant | |
| First aid and chemical/biological spill kits fully stocked and ready | [ ] Compliant [ ] Non-Compliant |
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Part 2 — Annual Safety Training & Observed Competency Tracking Register
Training covers: General Lab Biosafety & PPE, Sharps Handling, Chemical Hygiene (SDS), Biological Spills, Fire Safety, Disaster DRRM.
| Staff Name | Designation | Safety Topic Covered | Training Date | Delivery Format (Lecture / Demo / Drill) | Evaluation Result (Pass / Score) | Participant Signature | Evaluator Signature |
|---|---|---|---|---|---|---|---|
| Medical Technologist | YYYY-MM-DD | ||||||
| Medical Technologist | YYYY-MM-DD | ||||||
| Medical Technologist | YYYY-MM-DD | ||||||
| Medical Technologist | YYYY-MM-DD | ||||||
| Laboratory Aide | YYYY-MM-DD | ||||||
| Laboratory Aide | YYYY-MM-DD |
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Part 3 — Emergency & Disaster Drill Attendance and Performance Record
| Drill Date: | YYYY-MM-DD | Start / End Time: | HH:MM / HH:MM | Evacuation Area: | Hospital Grounds Assembly Point |
|---|---|---|---|---|---|
| Drill Type: | [ ] Earthquake Simulation [ ] Fire Evacuation [ ] Typhoon / Flood Response [ ] Power / Utility Outage Simulation |
3.1 Medical Technologists Drill Attendance & Roles
| Staff Name | Position | Assigned Emergency Function | Evacuation Time (Min:Sec) | Participant Signature |
|---|---|---|---|---|
| Chief Medical Technologist | Incident Command & Accountability | |||
| Medical Technologist | Specimen & Analyzer Securing | |||
| Medical Technologist | Patient Logbook & LIS Backup Protection | |||
| Medical Technologist | Evacuation Corridor Guidance |
3.2 Laboratory Aides Drill Attendance & Roles
| Staff Name | Position | Assigned Emergency Function | Evacuation Time (Min:Sec) | Participant Signature |
|---|---|---|---|---|
| Laboratory Aide | Power & Utility Disconnect Support | |||
| Laboratory Aide | Biohazard Waste & Reagent Securing |
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Part 4 — Safety Deficiencies Corrective Action Plan
| Deficient Item No. | Deficiency Description | Corrective Action Required | Responsible Person | Target Completion Date | Conformance Status |
|---|---|---|---|---|---|
| 1 | YYYY-MM-DD | [ ] Open [ ] Closed | |||
| 2 | YYYY-MM-DD | [ ] Open [ ] Closed |
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Part 5 — Annual Review and Endorsement
5.1 Medical Technologists
We confirm our participation in mandated safety training and emergency evacuation drills.
| Technologist Name | PRC License Number | Date | Signature |
|---|---|---|---|
5.2 Laboratory Aides
We confirm our participation in safety orientation, waste handling protocols, and facility evacuation drills.
| Laboratory Aide Name | Assigned Duty Station | Date | Signature |
|---|---|---|---|
5.3 Chief Medical Technologist / Laboratory Quality Manager
- Safety Program Compliance: [ ] 100% staff training verified [ ] Annual drill executed
- Signature: ________________________________________ Date: ____________________
5.4 Pathologist / Head of Laboratory
- Signature: ________________________________________ Date: ____________________