Door Sign Request Form

Program Overview

The EHS door sign program has been developed to help WCMC personnel and potential emergency responders identify the hazards present in an area (e.g. laboratory) prior to entering the room. At a minimum, an EHS door sign must be prepared and posted outside each doorway leading from a public hallway and the hazard assessment must be inclusive of all the interior rooms. If so desired, additional EHS door signs can be prepared for the interior rooms which more specifically identify the hazards in those specific areas. Click here for an example door sign.

Responsibility Area

Identify the initiating institution for the sign.

Weill Medical College of Cornell University
NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Contact Information

Let us know how to contact you, if we have questions about the information entered into this online form.

Distribution Instructions (choose one or both)

 

Space Information

Identify the primary space associated with this door sign. This is the door where the sign will hang. For multiple signs (e.g. a PI with a lab in Whitney and a lab in Harkness), complete the form multiple times.

Emergency Contact Information

Identify up to 3 contacts for the space. Note that emergency phone numbers can be removed from the printed door sign by selecting "No" for "Print emergency phone on sign?". The emergency phone numbers will be maintained by EHS in case of emergency.

Responsible Person 1

Responsible Person 2

Responsible Person 3

Access Restrictions and Requirements

Select the appropriate access restrictions and requirements for the space. Access Restriction 2 is optional.

Hazard Assessment

Select the most appropriate hazard rating for each category based on the criterion for “High Hazard”, “Moderate Hazard”, “Low Hazard”, or “Not Applicable”. Example chemicals and/or biological agents are available for certain hazard categories. Additionally, manufacturers will typically identify the related hazards for a chemical or biological agent on the original containers. If you have any questions, contact Environmental Health and Safety for assistance.

   

Biohazard

High Hazard Biosafety Levels 3 - Organisms that can cause serious illness or death in healthy adults. Exposure by inhalation is a risk from any sort of handling procedures or from spills or contaminated waste. Infections also readily occur from needle sticks or accidental contact with mucous membranes such as eyes and mouth. Example: Mycobacterium tuberculosis
Moderate Hazard Biosafety Level 2 - Organisms that can cause moderate to serious illness in healthy adults. Infections seldom occur via inhalation unless the organism is dispersed into the air as an aerosol. Infections readily occur from needle sticks or accidental contact with mucous membranes such as eyes and mouth. Examples: Salmonella bacteria, hepatitis B.
Low Hazard Biosafety Level 1 - Microbiology lab using microorganisms that do not cause disease in healthy adults. Example: E. coli K12 bacteria, most yeast
Not Applicable No biohazard present at this location.
   

Carcinogens (Examples)

High Hazard Routine use of larger quantities of carcinogenic material where the risk of exposure is high because the material can be absorbed through skin or inhaled. Examples: embalming facility and use of aerosolized carcinogens (e.g., smoking / nicotine studies)
Moderate Hazard Routine use of carcinogenic material in pure form. Examples: acrylamide powder, acrolein, or diaminobenzidine (DAB), or use of several liters per week of carcinogenic solvents, such as phenol/chloroform extraction procedures.
Low Hazard Occasional use of small amounts or dilute solutions. Example: Labs using small quantities of dilute formaldehyde/water solutions to preserve specimens
Not Applicable No carcinogens present at this location
   

Chemical Storage

High Hazard Chemical stockrooms, large quantities of hazardous materials, including 55 gallon drums. Storage of significant amounts of air or water reactive material, unstable or incompatible chemicals, and/or compressed or liquefied gases.
Moderate Hazard Storage of hundreds of chemical containers. Minimal amounts of air or water reactive material, unstable or incompatible chemicals, or compressed or liquefied gases. Example: chemical inventory of a standard research laboratory.
Low Hazard Storage of small quantities of chemicals. Storage where the amount on hand would not cause a fire or serious health hazard if it came into accidental contact with water. No storage of poison inhalation hazards. Example: chemical storage in a teaching lab.
Not Applicable No chemicals stored at this location.
   

Compressed Gases (Non-Flammable, Non-Poisonous) (Examples)

High Hazard Use of any compressed gases, including solidified or liquefied gases, in small unventilated space. Example: Use of liquid nitrogen or dry ice in a cold room or environmental chamber. (Note: This applies to rooms/chambers with re-circulating fans which do not supply fresh air.)
Moderate Hazard (1) Use of compressed gas with a low, well controlled flow rate in a area with poor ventilation; or (2) Use of a container or gas supply system that could cause the sudden release of a large amount of gas.
Low Hazard (1) Use where the release rate of the gas can be controlled; and (2) The area is well ventilated and air is not re-circulated. Example: Gas cylinder with regulator used in a well ventilated laboratory where air is exhausted by fume hoods that vent to the roof.
Not Applicable No compressed gases at this location.
   

Corrosives (Examples)

High Hazard (1) Use and/or storage of large quantities (20 or more gallons) of concentrated acids or bases; (2) Use or storage of any volume of hydrofluoric acid; and (3) Benchtop use of acid baths with acid concentrations of greater than 6 molar.
Moderate Hazard Use and/or storage of moderate quantities (1 to 20 gallons) of concentrated acids and bases. Example: standard research laboratory
Low Hazard Routine use of dilute acid and base solutions, infrequent use of concentrated acids and bases (less than 1 gallon). Example: use of corrosives in teaching laboratories
Not Applicable No corrosive materials at this location.
   

Explosives (Examples) and Peroxide Forming Chemicals (Examples)

High Hazard (1) Storage and/or use of any explosive materials in pure or concentrated forms or use in procedures which may produce harmful explosion; or (2) Use of peroxide forming chemicals in a procedure which may produce a harmful explosion Example: storage or use of dry picric acid; refluxing diethyl ether which may concentrate peroxides
Moderate Hazard (1) Storage and/or use of any peroxide forming chemicals; or (2) Work that involves amounts that can produce a harmful explosion but use is limited to forms, such as aqueous solutions, that are not explosive (e.g., Bouin’s fixative with picric acid)
Low Hazard Work that involves small amounts that can not produce a harmful explosion or use of the material in form that is not explosive. Example: histology lab using picric acid solution as a stain.
Not Applicable No explosive materials or peroxide forming chemicals at this location.
   

Flammable Gases (Examples)

High Hazard (1) The use and/or storage of any flammable gas cylinders below ground; or (2) The use and/or storage of the following:
  • >8 total cubic feet of flammable, liquefied gas
  • >10 total cubic feet of flammable, >300 PSIG, non-liquefied, non-absorbed gas
  • >30 total cubic feet of flammable, ≤300 PSIG, non-liquefied, non-absorbed gas
Moderate Hazard Use and/or storage of ≥0.15 cubic feet of flammable gas but less than the following:
  • <8 total cubic feet of flammable, liquefied gas
  • <10 total cubic feet of flammable, >300 PSIG, non-liquefied, non-absorbed gas
  • <30 total cubic feet of flammable, ≤300 PSIG, non-liquefied, non-absorbed gas
Low Hazard Use of small individual low-pressure containers (<0.15 cubic feet water container capacity of flammable gas) or piped supply systems. Example: house-supplied natural gas or aerosol can of spray paint with a flammable gas as a propellant
Not Applicable No flammable gases at this location.
   

Flammable Liquids (Examples)

High Hazard (1) Routine use or storage of any extremely flammable liquids {i.e., flashpoint <73F and boiling Point 95F}; or (2) Routine use or storage of large quantities (greater than 30 gallons); or (3) Any work with flammable liquids near an open flame or at elevated temperatures.
Moderate Hazard Routine use of flammable liquids in moderate quantities not exceeding FDNY permitted quantities and away from ignition sources. Example: Standard research lab.
Low Hazard Daily use or storage of small quantities (less than 32 fluid ounces) of flammable liquids. Example: tissue culture rooms using alcohol to wipe bench tops.
Not Applicable No flammable liquids at this location.
   

Flammable Solids, Air Reactive, and/or Pyrophoric Chemicals (Examples)

High Hazard Routine use or storage of large quantities of flammable solids (>15 lbs) or air reactive/ pyrophoric materials (>12 lbs).
Moderate Hazard Routine use or storage of moderate quantities of flammable solids (1-15 lbs) or air reactive/ pyrophoric materials (1-12 lbs).
Low Hazard Infrequent use of small quantities (<1 lb) under conditions known to be controllable.
Not Applicable No flammable solids / air reactives / pyrophorics at this location.
   

Ionizing Radiation

High Hazard Locations where an individual could receive a harmful exposure to radiation unless appropriate precautions are followed. Example: use of sealed sources that contain curie amounts of radioactive material.
Moderate Hazard Locations where an individual will not receive a harmful exposure if basic precautions are followed. Example: use of several millicuries of radioactive material that emit gamma or high energy beta radiation that requires shielding.
Low Hazard Locations where an individual could not receive a harmful exposure to ionizing radiation under any circumstances. Example: 1) laboratory where the total amount of radioactive material is less than the annual limit of intake for a radiation worker or 2) an X-ray diffraction unit that is entirely enclosed by shielding.
Not Applicable No ionizing radiation at this location.
   

Lasers

High Hazard Class IV laser is in use. Viewing of the direct beam and viewing of any type of reflection is likely to cause serious eye injury. Beams can cause skin burns. Beams can cause materials to burn and/or release hazardous materials to the air.
Moderate Hazard Class III laser is in use. Momentary viewing of the direct beam, or a beam reflected from a mirror-like surface, may produce serious eye injury. Beams may not be visible
Low Hazard Only class I or II lasers are in use. Beams from class I and II lasers are always visible. There is no risk of injury unless an individual looks directly into the beam for an extended period of time. Example: HeNe laser pointers used in classrooms
Not Applicable No lasers at this location.
   

Oxidizers (Examples)

High Hazard Routine use and storage of large quantities (>20 pounds) of strong oxidizers.
Moderate Hazard Routine use and storage of moderate quantities of oxidizers not exceeding 20 pounds. Example: standard research laboratory; chromic acid bath used to clean glassware; or storage of concentrated bleach.
Low Hazard Infrequent use of small quantities (less than 0.5 pounds total). Example: use of 10% hydrogen peroxide in an experiment
Not Applicable No oxidizers at this location.
   

Poisonous/Toxic Liquids and Solids (Examples)

High Hazard Use and storage of highly toxic chemicals (LD50 < 50 mg/kg).
Moderate Hazard Use and storage of toxic chemicals LD50 between 50 to 500 mg/kg) OR less toxic compounds which can be absorbed through the skin.
Low Hazard Use and storage of materials for which the lethal dose is more than an ounce (LD50 more than 500 mg/kg) and that are not readily absorbed through the skin. Examples: methyl ethyl ketone, acetaldehyde, benzoic acid, methanol, hexane
Not Applicable No poisonous liquids and solids at this location.
   

Poisonous Gases And Poison Inhalation Hazards (Examples)

High Hazard Any use or storage of a gaseous poison inhalation hazard.
Moderate Hazard Any use or storage of a liquid poison inhalation hazards.
Not Applicable No poisonous gases or poison inhalation hazards at this location.
   

Water Reactive Chemicals (Examples)

High Hazard Use or storage of large quantities (greater than 2 pounds) of water reactive chemicals or their use in new or original procedures that do not have a history of predictable results.
Moderate Hazard Routine use of small quantities (less than 2 pounds) under conditions known to be controllable. The amount on hand could cause a fire or serious health hazard if it came into accidental contact with water.
Low Hazard Infrequent use of small quantities under conditions known to be controllable. Storage where the amount on hand would not cause a fire or serious health hazard if it came into accidental contact with water.
Not Applicable No water reactive chemicals at this location.