Environmental Health and Safety Forms

Departmental Forms

Biological Safety

• IBC Registration Form (biosafety application)
• In vivo lab containment evaluation
• In vitro lab containment evaluation
• Biological Spill and Lab Specific Emergency plan Template

Physical Safety

Radiation Safety

• Corridor Storage Request

• Laboratory Contamination Survey
• Dosimetry Service Assessment and Exposure History Form
• Pregnancy Declaration, Instruction & Dosimetry Evaluation
• Application for Use of Radioactive Material
• Radioactive Waste Log
• Weekly Wipe Test Action Log

Exposure Control

Chemical Safety

• New Employee Exposure Assessment form
• Transfer Employee Exposure Assessment form
• HBV Acceptance/ Declination Form
• Consent to HIV Testing
• Contaminated Sharps Injury Report Form
  • Long form - MS Word .doc file
  • Short form - MS Word .doc file
  • Acrobat pdf file
  • Sharps Injury Survey Form
• Employee Exposure Notification & Medical Evaluation Option Form
• Certificate of Equivalent Training: Bloodborne Pathogens Safety Awareness & UTHSCSA's Exposure Control Plan