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DEHS Forms

by schmidy last modified Sep 26, 2013 10:53 AM

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 Self-Audit Checklist Word
   Documentation of Lab Specific Review of IBC PDF
   Documentation of Lab Specific Review of IACUC PDF
   Documentation of Lab Specific Review of ECP PDF
   Emergency SOP for Biohazardous Spills Word
   Emergency SOP for Exposure to Biohazards Word
   NIH Incident Reporting Template
Word
Bloodborne Pathogens Forms:
   Exposure Control Plan Word
   Hepatitis B Vaccine Offer Form PDF
   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 Registration User Guide Link
   IBC Application/Registration Link
   IBC Approved Research Annual Review Form Word
   IBC Approved Research Modification Request Form Word
   NIH Guidelines Classification Word
   Primary Reviewer Form Word
   Risk Communication for Infectious Agent Word
   Template Special Animal Safety Protocols (SASPs):
   Template for Standard Operating Procedures (SOPs)
Select Agent Forms:
   Select Agent Authorized User Verification Form Excel
   Select Agent Destruction Form PDF
   Select Agent Monthly Inventory Form Excel
   USA Patriot Act Employee Compliance Form
Chemical Hygiene and Laboratory Chemical Safety
   Chemical Hygiene Plan Template
   
  Chemical Inventory Template for Labs

   Lab Safety Audit Form
Word

Excel

PDF
   Lab Close-out and Equipment Release Notification Form Link
   List of Chemicals that Require Review by DEHS Excel
   SOP Template

   SOPs and SASPs Guidance Page
Word

Link
Environmental Management
    Excess Emissions
Link
Hazardous Materials Management and Waste Disposal
   Hazardous Waste Pick-up Form Link
   Waste Concentration Form PDF
Hazard Communication (Haz Com)
   Chemical Inventory Template Excel
   Haz Com Training Record Form Word
Radiation Safety
   Application for Authorization to Use Radioactive Material PDF
   Attachment to Authorization Application PDF
   Irradiator User Request Employment History (all employees must complete) PDF
   Irradiator User Request Employment History - employed more than 3 years PDF
   Irradiator User Request Employment History-employed less than 3 years PDF

   Laser Safety Set-up Evaluation

   Laser Registration

Word

PDF

   Waste Pick Up Request Form

   Dosimetry Badge Application Form

Link

PDF

Respiratory Protection
   Respirator Selection and Use Worksheet Word
   Worksite Information Regarding Respirator Use (to physician) Word
 


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