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.
Name:
Email:
Telephone:

 

DISTRIBUTION INSTRUCTIONS (choose one or both)
Print sign and mail to (Name and MailBox#):
Email an Acrobat PDF version of the sign to:  *Note: must print in color

 

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.

Space/Research Group Name:
Building:	NOT LISTED (specify in comments) -----SORTED BY BUILDING CODE----- A - Bldg (Harkness) B - Bldg C - Bldg D - Bldg E - Bldg F - Bldg (Baker Bldg) J - Bldg (NYPH) K - Bldg (NYPH) KB - Bldg (Kips Bay) L - Bldg (NYPH) LC - Bldg (Lasdon Biomedical Research Center) M - Bldg (NYPH) N - Bldg (NYPH) OX - Bldg (Oxford Bldg) P - Bldg (NYPH) S - Bldg SI - Bldg (Citigroup Imaging Center) ST - Bldg (Starr / NYPH) W - Bldg (Whitney) -----SORTED BY BUILDING NAME----- Ambulatory Care Building Annex Bldg Baker Bldg (F-Bldg / NYPH) Cantor Womens Health Center (425 East 61st Street) Citigroup Imaging Center (516 East 72nd Street) Finance (100 Broadway) Griffis Faculty Club Hamad bin Khalifa Biomedical Research Building Helmsley Tower Kips Bay (KB - Bldg) Lasdon House Livingston Farrand (423 Bldg) Livingston Farrand (425 Bldg) Livingston Farrand (427 Bldg) Magnetic Resonance Image Center (416 E. 55th St.) Midtown Center (56 West 45th Street) Olin Hall Oxford Building Payson House Residence Peripheral Neuropathy Center Phipps House Residence PO Billing Offices (575 Lexington Ave) Roosevelt Island (Southtown Residence) Southtown Residence (Roosevelt Island) Starr Bldg (NYPH) West Side Physician Offices (10 West 72nd Street) Whitney Building Wright Center for the Aging (1184 First Avenue) -----SORTED BY ADDRESS----- 100 Broadway (Finance) 1184 First Avenue (Wright Center for the Aging) 575 Lexington Ave (PO Billing Offices) 635 Madison Avenue (Peripheral Neuropathy Ctr) 56 West 45th Street (Midtown Center) 416 East 55th Street (MRSI) 425 East 61st Street 445 East 68th Street (Phipps House Residence) 445 East 69th Street (Olin Hall) 435 East 70th Street (Payson House Residence) 418 East 71st Street 515 East 71st Street (S - Bldg) 10 West 72nd Street (West Side Physician Offices) 125 East 72nd Street (Physicians Office) 422 East 72nd Street (Oxford Building) East 77th Street Residence (442 and 444)
Primary Room Number:
Department:	Non-WCMC Academic Affairs Accounting Admissions Affiliations Alumni Anesthesiology Anesthesiology - Physicians Organization Associate Dean Associate Provost Auxiliary Enterprises Biochemistry Budget Burke Rehabilitation Hospital Capital Planning Cardiothoracic - Physicians Organization Cardiothoracic Surgery Cardiovascular Center Cardiovascular Center - Physicians Organization Cell and Developmental Biology Center for Male Reproductive Medicine and Microsurgery Center for Male Reproductive Medicine and Microsurgery - Physicians Organization Center for Reproductive Medicine and Infertility Center for Reproductive Medicine and Infertility - Physicians Organization Center for Vascular Biology Computer Services Cornell Health Policy Cornell Internal Medicine Associates Dean Dean's Office Department Associates Dermatology Dermatology - Physicians Organization Development Emergency - Physicians Organization Facilities Management Faculty Affairs FASB-Accounting Finance Gene Therapy Core Facility Genetic Medicine Graduate School Griffis Faculty Club Gross Anatomy Housing Human Resources Information Technologies and Services Institute of Genetic Medicine Institutional Research Integrative Medicine Integrative Medicine - Physicians Organization Internal Audit Library MD Student MD/PHD Program Medicine Medicine - Physicians Organization Microbiology & Immunology Neurological Surgery Neurology - Physicians Organization Neurology and Neuroscience Neurosurgery - Physicians Organization Obstetrics and Gynecology Obstetrics and Gynecology - Physicians Organization Office of Billing Compliance Office of Network Affairs Office of the Secretary Ophthalmology Ophthalmology - Physicians Organization Orthopedic Surgery Otorhinolaryngology Otorhinolaryngology - Physicians Organization Pathology and Laboratory Medicine Pathology and Laboratory Medicine - PO Pediatrics Pediatrics - Physicians Organization Pharmacology Physician Assistant Program Physician Organization Physiology and Biophysics Planning Office Primary Care - Physicians Organization Psychiatry Psychiatry - Physicians Organization Psychiatry - Westchester Division Psychiatry - Westchester Division - Physicians Organization Public Affairs Public Health Public Health - Physicians Organization Radiology Radiology - Physicians Organization Rehabilitation Medicine Rehabilitation Medicine - Physicians Organization Research and Sponsored Programs Risk Management Rogosin Kidney Center Rogosin Kidney Center - Physicians Organization Strang Cancer Prevention Center Surgery Surgery - Physicians Organization University Counsel Office Urban Semester Program Urology Urology - Physicians Organization Vice Provost Weill Cornell Medical College in Qatar --------------------------
Division:	No Division Abdominal Radiology Academic (Non-Faculty) Academic Affairs Academic Computing Access Services Accounting Accounts Payable Administration Admissions Affirmative Action Alcohol & Dry Ice Allergy-Immunology Alumni Affairs Alumni Fund Raising Assistant Dean - Development Assistant Provost Bariatric Division Basic Science Biostatistics Breast Center Burn Center Cardiac Surgery Cardiology Cardiovascular Pathophysiology Cardiovascular Radiology Cataloging Cellular Neuroscience Cerebral Metabolism Cerebrovascular Chairman Chest - Radiology Child Development Child Protection CIMA Citigroup Imaging Center Clinical Geriatrics Clinical Neurophysiology Clinical Pharmacology Clinical Research Clinical Research Administrati Clinical Research Center Collection Development Colo-rectal Surgery Communications & Training Community And Public Health Program Community Relations Compensation Computer Services Computer Services - Library Continuing Medical Educaton Controller Cornell Medical Practice Critical Care Curriculum Support Center CV Starr Lab Dean GSMS Dean's Office Deans Office - Other Department Associates - Fund Raising Dermatology Development Campaign Development Office Digestive Diseases Dorms Duplicating Education Support Services Emergency & Musculosceletal Ra Emergency Medicine Emergency Room Employee Relation Employment Endocrinology Engineering and Maintenance Environmental Health and Safety Epilepsy Facilities Administration Facilities Development Facility Space Rental Faculty Affairs Federal Audit Compliance Finance - Programming Financial Management Fixed Asset Accounting FPP Accounting FPP Administration FPP Business Office FPP Physician Referal Fracture Garage Gastroenterology General General Anesthesiology General Internal Medicine General Medicine Consultants General Padiology General Radiology General Surgery Genetic Medicine Genetics Geographic Full Time Group Geriatrics-Gerontology Grants And Contracts Gross Anatomy GSMS Student Aid Health Policy Hematology Hematology/Oncology Housing HRIS Administration Human Resources - Benefits Human Resources - Personnel Human Rights Hypertension Immigration Immunology In Vitro Fertilization Indirect Cost Infectious Diseases Information Systems Intensive Care Internal Medical Associates International Medicine Interventional Neuroradiology IVF Queens Program Lab Non-Research/PO Business Laser Vision Correction Center Lenox Hill Library Managed Care Contracting Maternal/Fetal Medicine MD/PhD Administration MD/PhD Student Aid Medical Archives Medical Art & Photo Medical College-Transportation Medical Ethics Medical Practice Minority Affairs Molecular Medicine Muskuloskeletal-radiology Neonatology Nephrology Network Neurobiology Neurology Neuro-Radiology Neurosurgery NMR Nuclear Medicine Nursing Nutrition Office of Curriculum & Education Office of Health Physics Office of Network Affairs Office of the Secretary Offsite Practices Oncology Oral Surgery Orthopedic Surgery Others Outcomes And Effectiveness Res Outpatient Patient Accounting Payne Whitney Payroll Pediatric Neurology Pediatric Radiology Pediatric Surgery Pediatric Urology Physician Services And Marketing Physics Plastic Surgery PO Administration PO Affiliations PO Associate Dean PO Business Office PO Facilities PO Finance PO Financial Services PO Human Resources PO Oxford Building PO Physician Referral PO Surplus-Radiology Postdoctoral Affairs Practice Management Operations Prevention & Health Behavior Primary Care Administration Privacy Office Private Imaging Program in GABV Public Affairs - Campaign Public Affairs Office Pulmonary Critical Care Purchasing Quality Management Radiation Therapy Radiation-Oncology RASP Executive Office Records Rehabilitation Reproductive Medicine Research - Compliance Conflicts Research Accounting Research Animal Resource Center Research Compliance Research Compliance (IRB/IACUC) Research Development-RASP Research Support Responsible Conduct and Research Rheumatic Disease Senior Associate Dean - PO Senior Associate Dean of Research Senior Director Financial Mgt Shipping & Receiving Space Management Special RASP Programs Special Studies Center Sr Assoc Dean-Finance Student Accounting Student Affairs Student Health Services Student Programs Subsidiary Accounting Surgery Surgical Oncology Surgical Research Systems Accounting Technology Development Training Grant Transplantation Surgery Trauma Center Ultrasound / Body Computer Tomography Unnamed Urology Vascular Surgery Ward Chief WCMC-Q Admissions & Student Affairs WCMC-Q Dean's Office WCMC-Q Facilities Management WCMC-Q Finance Office WCMC-Q Human Resources WCMC-Q Information Technology WCMC-Q Library WCMC-Q Medical Education WCMC-Q Pre-medical Education WCMC-Q Public Relation WCMC-Q Research Web Based Services Westchester Women's Health Women's Imaging Wound Healing Service --------------------------

 

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
Name (First Last)
Office Phone
Emergency Phone
Print emergency phone on sign?	Yes No
Responsible Person 2
Name (First Last)
Office Phone
Emergency Phone
Print emergency phone on sign?	Yes No
Responsible Person 3
Name (First Last)
Office Phone
Emergency Phone
Print emergency phone on sign?	Yes No

 

ACCESS RESTRICTIONS AND REQUIREMENTS

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

Restriction 1	Faculty, Staff, and Students Faculty and Staff Research Group Members Individuals with Permission of Facility Manager Individuals with Permission of Principal Investigator Authorized Users Only Visitors Must be Escorted
Restriction 2	N/A Faculty, Staff, and Students Faculty and Staff Research Group Members Individuals with Permission of Facility Manager Individuals with Permission of Principal Investigator Authorized Users Only Visitors Must be Escorted
Door Security	Door Must be Kept Locked at All Times Door Must be Kept Locked During Off-Hours and Weekends Door Must be Kept Locked When Research Members Leave Lab Door Must be Kept Locked When Class is Not in Session Door Must be Kept Locked When Not in Use
PPE	Eye Protection & Gloves Required When Using Hazardous Chemicals Eye Protection Required at All Times Eye Protection Required at All Times in Chemical Area Eye Protection Required in Lab Area Eye Protection Required When Using Hazardous Chemicals Eye Protection Required When Using Lasers

 

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 (Examples)
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.