Appendix H

U.C. Santa Cruz Safety Training Needs Identification Work Sheet

Employee/Job Class:______________________________	Supervisor:___________________________
Departartment:___________________________________	Date:_________________________________

A. Safety Program Awareness

	Needed	Completed
1 Injury & Illness Program	_______	________
2. Hazard Communication	_______	________

B. General and Office Safety

	Needed	Completed
1. Ergonomic / VDT Use	_______	________
2. Back Care (Push/Pull/Bend/Lift Cont Stnd)	_______	________
3. Emergency Response/Disaster Plan	_______	________
4. Seismic Considerations	_______	________

C. Industrial/Physical Hazards

	Needed	Completed
1. Climbing Ladders Tree Trimming Elevated Platforms	______ ______ ______	________ ______ ______
2. Confined Spaces Manholes	______	________
3. Electrical/High Voltage	______	________
4. Lockout/Tagout	______	________
5 High Noise Levels	______	________
6. Welding /Cutting	______	________
7. Vehicles - Auto/Truck Forklift Industrial Trucks Lift Trucks	______ ______ ______ ______	________ ________ ________ ________
8. Shop Tools	______	________
9. Other Industrial Equip (specify)	______	________

D. Engineering/Personal Protection

	Needed	Completed
1. Personal Protective Equipment Respirators Gloves Eye Protection (Goggles/Face Shield/Glasses)	______ ______ ______ ______	________ ________ ________ ________
2. Local Exhaust Hoods	______	________
3. Other Special Mechanical Exhaust Ventilation	______	________
4. Shower Eyewash	______	________

E. Hazardous Materials

	Needed	Completed
1.Compressed Gasses Flammable Corrosive Pyrophoric Oxidizing Toxic Inert	______ ______ ______ ______ ______ ______	________ ________ ________ ________ ________ ________
2. Corrosives Oxidizing Acids Mineral Acids Organic Acids Bases	______ ______ ______ ______	________ ________ ________ ________
3. Flamables Liquids Solids	______ ______	________ ________
4. Organic Solvents Halogenated Non-Halogenated	______ ______ ______	________ ________ ________
5. Water Reactives	______	________
6. Oxidizers	______	________
7. Reducers	______	________
8. Irritants/Sensitizers	______	________
9. Radioactive Materials	______	________
10. Biohazards Infectious Recomb. DNA BioTechnology Work with Animals	______ ______ ______ ______	________ ________ ________ ________
11. Carcinogens/Mutagens Teratogens (see list)	______	________
12. Pesticides / Herbicides	______	________
13. Cryogenic Materials	______	________
14. Drugs and Controlled Substances	______	________

F. Specifically Regulated Chemicals

	Needed	Completed
1. Heavy Metals Lead Inorganic Arsenic Cadmium Mercury Others	______ ______ ______ ______ ______	________ ________ ________ ________ ________
2. Formaldehyde	______	________

	Needed	Completed
3. Peroxide Formers Ethers Tetrahydrofuran Dioxane Others	______ ______ ______ ______	________ ________ ________ ________
4. Potential Explosives Picric Acid TNT Others	______ ______ ______	________ ________ ________
5. Perchloric Acid	______	________
6. Asbestos	______	________
7. Other Highly Toxics	______	________

G. Laboratory Operations

	Needed	Completed
1. Chemical Fume Hoods	______	________
2. Highly Hazard Electrical Equipment Electrophoresis Other	______ ______	________ ________
3. Temperature / Pressure Sterilization Equipment NMR Centrifuge Other	______ ______ ______ ______	________ ________ ________ ________
4. Radiation Producing Equipement X-ray generators Microwave Lasers	______ ______ ______	________ ________ ________
5. Chemical/Analytical Equipment Gas Chromatography HPLC \|DNA Synthesizer Atomic Absorption Other	______ ______ ______ ______ ______	________ ________ ________ ________ ________
6. Solvent Distilation / Recovery Units	______	________
7. Ultraviolent Lamps	______	________
8. Sharps	______	________
9. Special Glassware	______	________
10. Food Consumption	______	________

Comments:_______________________________
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