OSHA Form ICS-4 Personal Protective Equipment Hazard Assessment for Laboratory Workers

Form ICS-4 is a U.S. Department of Labor - Occupational Safety & Health Administration form also known as the "Personal Protective Equipment Hazard Assessment For Laboratory Workers". The latest edition of the form was released in June 1, 2005 and is available for digital filing.

Download a PDF version of the Form ICS-4 down below or find it on U.S. Department of Labor - Occupational Safety & Health Administration Forms website.

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APPENDIX B
FORM LCS-4
Personal Protective Equipment
Hazard Assessment
for Laboratory Workers
The Occupational Safety and Health Administration (OSHA) requires a personal protective equipment hazard
assessment for any tasks that require personal protective equipment (e.g., gloves, safety glasses). Please check
all activities that apply to your area. If a task is not listed add a new task at the bottom with the associated
hazards and personal protective equipment (PPE). Please complete the hazard assessment for your laboratory
and keep it in Appendix B of the Laboratory Chemical Safety Plan.
Date: _____________________
Supervisor/PI: _______________________________ Assessment by: ___________________________
Department: _______________________ Building/Room Number(s): ___________________________
Chemical Hazards
Check
All That
Task
Potential Hazard
Recommended PPE
Apply
Safety glasses or goggles
Working with small volumes of
Skin or eye damage
Light chemically resistant gloves
corrosive liquids (< 1 liter).
Lab coat, closed shoe, pants
Working with large volumes of
Large surface area skin or
Safety goggles and face shield
corrosive liquids (> 1 liter),
eye damage, poisoning, or
Heavy chemically resistant gloves
acutely toxic corrosives, or work
great potential for eye and
Lab coat, closed shoe, pants, and chemically
which creates a splash hazard
skin damage
resistant apron
Skin or eye damage
Safety glasses or goggles
Working with small volumes of
Slight poisoning potential
Light chemically resistant gloves
organic solvents (< 1 liter).
through skin contact
Lab coat, closed shoe, pants
Working with large volumes of
Safety goggles and face shield
Major skin or eye damage, or
organic solvents (> 1 liter), very
Heavy chemically resistant gloves
potential poisoning through
dangerous solvents, or work
Lab coat, closed shoe, pants, and chemically
skin contact
which creates a splash hazard
resistant apron
Potential skin or eye damage,
Safety glasses (goggles for large quantities),
Working with toxic or hazardous
potential poisoning through
light chemically resistant gloves,
chemicals (solid or liquid).
skin contact.
lab coat, closed shoe, pants.
Great potential skin or eye
Safety goggles,
Working with acutely toxic or
damage, great potential
appropriate heavy chemically resistant gloves,
hazardous chemicals (solid or
poisoning through skin
lab coat, closed shoe, pants
liquid).
contact.
Coveralls and booties if necessary.
Skin or eye damage from
Blast shield, safety goggles or full face shield,
Working with explosives.
flying projectiles or
chemically resistant gloves,
chemicals.
lab coat, closed shoe, pants.
Safety glasses or goggles, appropriate gloves, lab
Skin or eye damage,
Working with chemical dusts.
coat, closed shoes or boots if necessary, pants,
respiratory damage.
Approved respiratory protection (call EHS).
Safety glasses or goggles,
appropriate gloves,
Skin or eye damage,
Chemical spill cleanup.
lab coat, closed shoes or boots if necessary,
respiratory damage.
pants,
respiratory protection (call EHS).
Radiological Hazards
Potential cell damage,
Working with solid radioactive
Safety glasses, gloves, lab coat, closed shoe,
potential spread of
materials or waste.
pants.
radioactive materials.
Working with radioactive
Potential cell damage or
Safety glasses (or goggles for splash hazard),
chemicals (corrosives,
spread of contamination plus
light chemically resistant gloves,
flammables, liquids, powders,
hazards for the appropriate
lab coat, closed shoe, pants.
etc.).
chemical hazards above.
Use PPE for applicable chemical hazards above.
Conjunctivitis,
Working with ultraviolet
UV face shield and goggles,
corneal damage,
radiation.
lab coat, closed shoe, pants.
erythema.
Appropriate shaded goggles with optical density
Retinal eye damage,
based on individual beam parameters,
Working with Laser radiation.
skin damage.
lab coat, closed shoe, pants.
No jewelry or reflective items allowed.
B-5
Jun 05
APPENDIX B
FORM LCS-4
Personal Protective Equipment
Hazard Assessment
for Laboratory Workers
The Occupational Safety and Health Administration (OSHA) requires a personal protective equipment hazard
assessment for any tasks that require personal protective equipment (e.g., gloves, safety glasses). Please check
all activities that apply to your area. If a task is not listed add a new task at the bottom with the associated
hazards and personal protective equipment (PPE). Please complete the hazard assessment for your laboratory
and keep it in Appendix B of the Laboratory Chemical Safety Plan.
Date: _____________________
Supervisor/PI: _______________________________ Assessment by: ___________________________
Department: _______________________ Building/Room Number(s): ___________________________
Chemical Hazards
Check
All That
Task
Potential Hazard
Recommended PPE
Apply
Safety glasses or goggles
Working with small volumes of
Skin or eye damage
Light chemically resistant gloves
corrosive liquids (< 1 liter).
Lab coat, closed shoe, pants
Working with large volumes of
Large surface area skin or
Safety goggles and face shield
corrosive liquids (> 1 liter),
eye damage, poisoning, or
Heavy chemically resistant gloves
acutely toxic corrosives, or work
great potential for eye and
Lab coat, closed shoe, pants, and chemically
which creates a splash hazard
skin damage
resistant apron
Skin or eye damage
Safety glasses or goggles
Working with small volumes of
Slight poisoning potential
Light chemically resistant gloves
organic solvents (< 1 liter).
through skin contact
Lab coat, closed shoe, pants
Working with large volumes of
Safety goggles and face shield
Major skin or eye damage, or
organic solvents (> 1 liter), very
Heavy chemically resistant gloves
potential poisoning through
dangerous solvents, or work
Lab coat, closed shoe, pants, and chemically
skin contact
which creates a splash hazard
resistant apron
Potential skin or eye damage,
Safety glasses (goggles for large quantities),
Working with toxic or hazardous
potential poisoning through
light chemically resistant gloves,
chemicals (solid or liquid).
skin contact.
lab coat, closed shoe, pants.
Great potential skin or eye
Safety goggles,
Working with acutely toxic or
damage, great potential
appropriate heavy chemically resistant gloves,
hazardous chemicals (solid or
poisoning through skin
lab coat, closed shoe, pants
liquid).
contact.
Coveralls and booties if necessary.
Skin or eye damage from
Blast shield, safety goggles or full face shield,
Working with explosives.
flying projectiles or
chemically resistant gloves,
chemicals.
lab coat, closed shoe, pants.
Safety glasses or goggles, appropriate gloves, lab
Skin or eye damage,
Working with chemical dusts.
coat, closed shoes or boots if necessary, pants,
respiratory damage.
Approved respiratory protection (call EHS).
Safety glasses or goggles,
appropriate gloves,
Skin or eye damage,
Chemical spill cleanup.
lab coat, closed shoes or boots if necessary,
respiratory damage.
pants,
respiratory protection (call EHS).
Radiological Hazards
Potential cell damage,
Working with solid radioactive
Safety glasses, gloves, lab coat, closed shoe,
potential spread of
materials or waste.
pants.
radioactive materials.
Working with radioactive
Potential cell damage or
Safety glasses (or goggles for splash hazard),
chemicals (corrosives,
spread of contamination plus
light chemically resistant gloves,
flammables, liquids, powders,
hazards for the appropriate
lab coat, closed shoe, pants.
etc.).
chemical hazards above.
Use PPE for applicable chemical hazards above.
Conjunctivitis,
Working with ultraviolet
UV face shield and goggles,
corneal damage,
radiation.
lab coat, closed shoe, pants.
erythema.
Appropriate shaded goggles with optical density
Retinal eye damage,
based on individual beam parameters,
Working with Laser radiation.
skin damage.
lab coat, closed shoe, pants.
No jewelry or reflective items allowed.
B-5
Jun 05
APPENDIX B
FORM LCS-4
Check
All
Task
Potential Hazard
Recommended PPE
That
Apply
Working with infrared emitting
Cataracts,
Appropriate shaded goggles,
equipment (e.g., glass blowing).
flash burns to cornea.
lab coat, closed shoe, pants.
Potential cell damage,
Working with radioactive human
Safety glasses (goggles for splash hazard),
potential spread of
blood, body fluids, or blood
light latex gloves,
radioactive contaminants, or
borne pathogens (BBP).
lab coat, closed shoe, pants.
potential BBP exposure.
Biological Hazards
Working with small volumes of
Potential contraction of
Safety glasses,
human blood, body fluids,
infectious disease, potential
light latex gloves,
tissues, or blood borne
spread of infectious disease.
lab coat, closed shoe, pants.
pathogens.
Increased potential for
Working with large volumes of
Safety goggles with face shield,
contraction of infectious
human blood, body fluids,
latex gloves,
disease or increased
tissues, or blood borne
lab coat, closed shoe, pants.
potential for spread of
pathogens.
Coveralls and boot covers if necessary.
infectious disease.
Animal bites, stings, or
infectious disease.
Safety glasses or goggles,
Working with live or poisonous
Skin or eye damage from
protective gloves,
animals and plants.
contact with animal or plant
lab coat, closed shoe, pants.
poisons.
Potential exposure to
Working with animal specimens
Safety glasses or goggles, protective gloves, lab
infectious disease, animal
(preserved or unpreserved).
coat, closed shoe, pants.
toxins, or preservatives.
Physical Hazards
Safety glasses or goggles for large volumes,
Major skin, tissue, or eye
Working with cryogenic liquids.
heavy insulated gloves,
damage.
lab coat, closed shoe, pants.
Safety glasses,
Working with very cold
Frostbite, hypothermia.
insulated gloves and warm clothing,
equipment or dry ice.
lab coat, closed shoe, pants.
Working with hot liquids,
Safety glasses or goggles for large volumes,
equipment, open flames
Burns resulting in skin or eye
insulated gloves,
(autoclave, bunsen burner,
damage.
lab coat, closed shoe, pants.
water bath, oil bath).
Conjunctivitis, corneal
Appropriate shaded goggles and face shield,
Metal arc or tungsten arc (TIG)
damage, erythema,
gloves,
welding.
skin burns.
lab coat, closed shoe, pants.
Eye damage from foreign
Safety glasses,
Instrument repair.
objects.
no loose clothing or jewelry.
Eye damage from foreign
Safety glasses,
objects,
Metal or woodworking.
gloves,
lacerations from burrs or
no loose clothing or jewelry.
splinters.
Safety goggles, appropriate gloves, lab coat,
Skin or eye damage,
closed shoes or boots if necessary, pants, NIOSH
Working in nuisance dusts.
respiratory damage.
approved dust mask or other respiratory
protection (call EHS).
Heavy rubber gloves,
Glassware washing.
Lacerations.
lab coat, closed shoes, pants.
Working with loud equipment,
Potential ear damage and
Ear plugs or headphones as necessary.
noises, sounds, or alarms, etc.
hearing loss.
New Tasks or Other Hazards
Check
All That
Task
Potential Hazard
Recommended PPE
Apply
Exempted Areas
(Use the following space to describe protected lab areas where PPE is not required)
Check
Physical Barrier (ie wall,
All
Lab Area
Exemption (eyewear, gloves, etc.)
curtain, lab bench)
That
B-6
Jun 05

Download OSHA Form ICS-4 Personal Protective Equipment Hazard Assessment for Laboratory Workers

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