Document Actions
DEHS Forms
The following forms are used by the UofL Department of Environmental Health and Safety and their constituents. If you do not find a form, please contact DEHS at (502) 852-6670 for assistance.
| Biological Safety | |
| Biohazard Sign Request Form | Word |
| Biological Safety Laboratory Checklist | Word |
| Emergency SOP for Biohazardous Spills | Word |
| Emergency SOP for Exposure to Biohazards | Word |
| Bloodborne Pathogens Forms: | |
| Hepatitis B Vaccine Offer Form | |
| Exposure Control Plan | Word |
| Supervisor's Training Record and HBV Offer | Word |
| Department of Defense (DOD) Certificate of Environmental Compliance (CEC) Forms: | |
| Certificate of Environmental Compliance Form | Word |
| Principal Investigator Safety Program Assurance Form | Word |
| UofL Principal Investigator Hazardous Material Approval Assurance Form | Word |
| Institutional Biosafety Committee (IBC) Forms: | |
| IBC Application Form Instructions | Word |
| IBC Application/Registration Form | Word |
| IBC Bloodborne Pathogens Application/Registration Form | Word |
| Worksheet #1 - NIH Recombinant DNA Classification | Word |
| Worksheet #2 - Select Agents | Word |
| Worksheet #3 - Human Gene Therapy | Word |
| Worksheet #4 - USDA Regulated Agents | Word |
| Worksheet #5 - Bloodborne Pathogens | Word |
| Appendix M - Human Gene Therapy | Word |
| IBC Approved Research Annual Review Form | Word |
| IBC Approved Research Modification Request Form | Word |
| Primary Reviewer Form | Word |
| Template Special Animal Safety Protocols (SASPs): | |
| Template for Standard Operating Procedures (SOPs) | |
| Risk Communication for Infectious Agent | Word |
| Select Agent Forms: | |
| Select Agent Authorized User Verification Form | Excel |
| Select Agent Destruction Form | Word |
| Select Agent Monthly Inventory Form | Excel |
| Select Agent Registration Form | Word |
| USA Patriot Act Employee Compliance Form | |
| Chemical Hygiene and Laboratory Chemical Safety | |
| Lab Safety Audit Form | |
| Lab Close-out and Equipment Release Notification Form | link |
| Chemical Inventory Template for Labs (optional) | Excel |
| SOP Template | Word |
| Environmental Management | |
| Hazardous Materials Management and Waste Disposal | |
| Hazardous Waste Pick-up Form | link |
| Waste Concentration Form | |
| Hazard Communication (Haz Com) | |
| Chemical Inventory Template | Excel |
| Haz Com Training Record Form | Word |
| Radiation Safety | |
| Application for Authorization to Use Radioactive Material | |
| Attachment to Authorization Application | |
| Irradiator User Request Employment History | Word |
| Irradiator User Request Employment History-all current employees | Word |
| Irradiator User Request Employment History-less than 3 years | Word |
| Laser Safety Set-up Evaluation | Word |
| Waste Pick Up Request Form | link |
| Respiratory Protection | |
| OSHA Medical Evaluation Questionnaire (to physician) | |
| Respirator Selection and Use Worksheet | Word |
| Worksite Information Regarding Respirator Use (to physician) | Word |
last modified
2008-10-09 13:45
Home
About Us
Index A-to-Z
Find People
Contact Us