Chapter 22: LABORATORY DECOMMISSIONING AND REPURPOSING POLICY
Effective Date: September, 2017
Last Updated: December, 2014
1. Purpose
Laboratory decommissioning is a process to vacate a laboratory and its associated infrastructure to a condition that meets environmental health and safety requirements for the next use. It is to be conducted when vacating, renovating, repurposing or terminating a laboratory. It involves removing hazardous materials, disposing of unwanted materials, emptying and decontaminating equipment and laboratory apparatus. This policy is established to ensure safe decommissioning of all teaching and research laboratories and auxiliary laboratory supporting areas in HKUST, and the safety of the next occupants and other personnel who may access or use those areas.
This policy stipulates the responsibilities of all involved parties and provides guidelines for efficient and effective laboratory decommissioning in accordance with American National Standard for Laboratory Decommissioning ANSI Z9.11-2008.
2. Scope
This policy is applicable for laboratory decommissioning or repurposing whenever vacating, relocating, renovating or terminating a laboratory is needed.
3. Roles and Responsibilities
3.1 FACULTY MEMBER IN CHARGE OR PRINCIPAL INVESTIGATOR (PI)
It is the responsibility of PI to:
3.1.1 Initiate and follow through the decommissioning procedures according to Section 4 below.
3.1.2 Ensure that employees and/or students involved in the decommissioning exercise:
- Are familiar with this policy and related procedures;
- Have attended relevant safety training provided by Health, Safety and Environment Office (HSEO), such as biological safety, chemical safety, radiation safety, laser safety, etc.;
- Have received hands-on training from PI or supervisor; and
- Work in compliance with requirements of this document and other relevant university health, safety and environment requirements.
3.1.3 Notify HSEO in advance of relocation of any radioactive sources, irradiating apparatus and pressure vessels.
3.1.4 Ensure implementation of appropriate safety measures for transfer or disposal of hazardous, radioactive, and/or biological materials in accordance with relevant legal requirements.
3.1.5 Ensure proper disposal of electronic appliance, lead acid battery and animal carcasses following relevant environmental regulations.
3.2 DEPARTMENT HEAD AND DEPARTMENTAL SAFETY OFFICER (DSO)
It is the responsibility of Department Head and Departmental Safety Officer to:
3.2.1 Ensure all faculty members are aware of and comply with this policy.
3.2.2 Ensure all parties involved in vacating or relocating a laboratory have been well notified.
3.2.3 Verify that the responsible faculty member has cleared all hazardous materials and equipment before he/she leaves the University.
3.3 CAMPUS MANAGEMENT OFFICE (CMO)
It is the responsibility of the Facilities Management Office to:
3.3.1 Consult the Decommissioning Flowchart and Checklist (Appendix II) whenever request for laboratory relocation, termination, or major modification is received, and remind concerned faculty member to initiate Laboratory Decommissioning and Repurposing process when necessary.
3.3.2 Coordinate activities of all parties.
3.3.3 Manage and perform planning, design and construction.
3.3.4 Supervise contractors for safe construction.
3.3.5 Inform HSEO if any abnormalities are observed during laboratory decommissioning.
3.4 HEALTH, SAFETY AND ENVIRONMENT OFFICE (HSEO)
It is the responsibility of the Health, Safety and Environment Office to:
3.4.1 Assist the faculty members and CMO with the laboratory decommissioning.
3.4.2 Provide technical guidance and support to faculty members, and CMO during laboratory decommissioning.
3.4.3 Ensure the decommissioning complies with legal requirement, policies, and guidelines.
3.4.4 Advise on decontamination and waste disposal.
3.4.5 Perform site inspection, sampling analysis or risk assessment to minimize risks.
3.4.6 Verify the following for the vacated laboratory:
- All hazardous materials have been properly removed, disposed of and/or stored;
- All equipment and laboratory apparatus have been emptied and decontaminated; and
- The vacated laboratory is free of hazard.
3.4.7 Notify CMO and faculty members the survey results.
3.4.8 Perform clearance inspection for the vacated laboratory prior to returning the laboratory to CMO.
4. Procedure
4.1 INITIAL ASSESSMENT OF LABORATORY FOR DECOMMISSIONING
PI shall review the Decommissioning Flowchart and Checklist and select relevant sections in which decommissioning procedure is required, and then contact HSEO representative for an initial site assessment. The assessment should define the scope of the decommissioning exercise with reference to the checklist filled out by the user and any other issues identified during the site assessment. HSEO representative will brief lab users about relevant procedures required for handling, cleaning, decontaminating, and packing of hazardous materials and equipment.
4.2 LABORATORY CLEANUP AND WASTE DISPOSAL
Wastes shall be disposed of in accordance with relevant legal requirements. Experimental equipment shall be emptied and decontaminated before removal or disposal. Follow Laboratory Decommissioning Flowchart and Checklist for detailed guidelines and procedures.
4.3 SIGNING OFF
- Upon completion of the laboratory decommissioning exercise, user is required to submit the completed decommissioning checklist (Appendix II) to HSEO and arrange a clearance inspection.
- HSEO representative will sign off the decommissioning exercise after the clearance inspection when all items are found to be in order.
5. Moving into New Laboratory
When moving into the new laboratory, Faculty Members or PIs shall:
- Update Placard information by filling the form of “ Registration of Hazard Warnings”
- Update the risk assessment database.
- Update hazard material inventory
- Update autoclave license as necessary.
- Update radioactive materials inventory and apply for radiation license and radiation use authorization permit as necessary.
- Update laser hazard control plan as necessary.
- Segregate chemicals by hazard classification.
- Request CMO-LS certification services for biological safety cabinets and chemical fume hoods.
- Provide adequate spill kits and first aid kits.
- Request for metal powder fire extinguisher as necessary.
- Prepare fire escape route plan for new laboratory.
Appendix
Laboratory Decommissioning and Repurposing Flow Chart
Appendix I - Laboratory Decommissioning and Repurposing Checklist