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I. Laboratory Data
Name
Address
City
Postal Code
Country
e-mail
Type of Laboratory
N-Samples per year
II. WorkLoad
Specimen Receipt How long Specimen
Preparation How long Preparation
Microscopical How long Microscopical
Decontamination How long Decontamination
Culture How long Culture
Radiometric (Bactec) How long Bactec
Waste Disposal How long Waste
Measures Apply for Disposal

Maintenance of Laboratory
Ultraviolet Lamps How long UV Lamps
Filters How long Filters
Incubators How long Incubators
Centrifuges How long Centrifuges
Microscope How long Microscope
Other How long Other

Clean and Desinfect
Surfaces
Work Surface
Daily
Disinfectant

Materials
The material
Daily
Method

Clinical Samples Types at your Lab
Sputum
Blood
Urine
Pleural Specimen
Synovial Specimen
LCR
Biopsy
Organic Liquid

Cultures
Indetification
Sensitivity
III. Workers Training
Biological Hazards
Appropiate Occupational Measures
Safety Measures
IV. Workers Information
Aware Hazards


Informed About Them
When start ?
When Change Job
When Regularly





Informed Staff
Guidelines
Incident (Last 3 years)
Incident Type
Professional Disease
V. Safety Practices
Separete Place
Enough Room
Restricted Area
Air Filtered HEPA
Negative Pressurization
Specimens Safety Kept
Surface
Airtight Containers
Security Test Tube
Inoculating Loops
Pipette Automatic

After use neddles and syringes
Separate
Reencapsulate
Solid Container

Personal Protective Equipment
Open Front Coats
Solid Front Coats
Coats Elastics Cuffs
Surgical Masks
Biosafety Masks
Gloves
Caps
Locker Work Clothing
Leave Laboratory with work clothing
Washing Work Clothing

Work Clothing Contamined
Separate
Decontaminate
Laundry

Safety Work
Smoking Eating
First Aid Kit
Eye Washing
Shower
Biological Safety Cabinets
Type

Biological Safety Cabinet Class
I BSC
II A BSC
II B1 BSC
II B2 BSC
II B3 BSC
III BSC

Activities deployment at your Lab
Pipette

Tube Opening/Closing

Specimen Tube Opening

Agitation



Maintenance of BSC
How Often (Months)
Guidelines Maintenance BSC

Centrifug. Maintenance Guidelines Centrifuges

Immunizations Chemoprophilaxis
Tetanus
Hepatitis B
BCG
Other Inmunization Chemoprophilaxis (INH)

Medical Examination
Medical Examination Before
Regular Medical Examination
How often
Form filled by
Completed By
Author Name
Date (DD-MM-YYYY)

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