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| Title | Short Description | EHS Program | Contact |
|---|---|---|---|
| Accident Report Form Flowchart | Flow chart outlining all forms to complete for an occupational accidental incident | Occupational Health | 919-515-6852 |
| Autoclave Log | Sample log for autoclave users | Biosafety | 919-515-6858 |
| Biological Inventory Sample Form | Download this document as a sample of biological inventory | Biosafety | 919-515-6858 |
| Biological Use Authorization (BUA) form | Registration and approval for use of biological materials | Biosafety | 919-515-6858 |
| Biosafety Cabinet Out of Service | Biosafety cabinets must be posted prominently with this form if the unit goes into alarm, needs service for any reason, upon setting up or moving a biosafety cabinet prior to certification, or if the units last certification is beyond 12 months. | Biosafety | 919-515-6858 |
| Biosafety Clearance Form | Clearance for maintenance/surplus of biosafety cabinets, freezers, fridges, incubators, etc. | Biosafety | 919-515-6858 |
| Biosafety in Teaching Labs | Form to be completed by the Course Instructor and submitted with the Biological Use Authorization for courses that require level 2 containment. | Biosafety | 919-515-6858 |
| Chemical Hood Owner Reference Information | Informs users about the fume hood program and their responsibilities in using and maintain a safe and dependable fume hood | Lab Safety | 919-513-1282 |
| Exam Request and Authorization For Release Of Medical Information Form | The forms to been seen by a doctor for an Occupational Medicine Exam and the release of the exam results | Occupational Health | 919-515-6862 |
| Fume Hood Project Tracking Form | Fume hood installation/renovation project tracking form | Lab Safety | 919-513-1282 |
| Hearing Conservation Program Log | Fillable form for logging hearing protection use and requirement | Occupational Health | 919-515-6862 |
| Laboratory Relocation Guidance and Start-up Checklist | forms can be used to open a new lab, close or move your existing laboratory space on campus | Lab Safety | 919-515-6860 |
| Medical Surveillance | Purpose of medical surveillance is early identification of conditions, that could present an increased risk of adverse health effects related to the task being performed. | Occupational Health | 919-515-6862 |
| Minors As Volunteer Workers Involved In Field, Laboratory, or Teaching Activities | For persons under 18 years of age this document contains the release of lability and waiver claim, and outlines the proper training requirements | Administration | 919-515-6860 |
| New Principal Investigators & Lab Managers | Outlines the forms required during the application process to use radioactive materials (excluding human or animal use) | Radiation Safety | 919-515-2894 |
| OCCUPATIONAL MEDICINE PROGRAM HEP B DECLINATION FORM | Acknowledging the risk of not vaccinating for HEP B | Biosafety | 919-515-6858 |
| Part D: Biological Agents Section of BUA | Use the Part D as indicated in the instructions of the BUA. | Biosafety | 919-515-6858 |
| Radiation Safety Forms | Summary of all the Radiation Safety Forms | Radiation Safety | 919-515-2894 |
| Requirements For Startup of BSL-3 Facilities | This checklist provides a summary of key steps to verify new BSL-3 facilities meet university requirements. | Biosafety | 919-515-6858 |
| RS-1/RS-2: Instruction For The Completion of RS-2/ Application For Non-Human Use of Radioactive Material | This form is for researchers desiring to use radioactive materials in a laboratory setting | Radiation Safety | 919-515-2894 |
| RS-3: Radiation Worker Registration Form | This form is used for new employees who will be working with radioactive materials or radiation-producing devices | Radiation Safety | 919-515-2894 |
| RS-4: Dosimetry Service Assessment and Exposure History Form | This form is used to determine what dosimetry is appropriate for each worker and to obtain any prior exposure records | Radiation Safety | 919-515-2894 |
| RS-5: Radioactive Material Authorization Amendment Form | This form may be used to amend an approved protocol | Radiation Safety | 919-515-2894 |
| RS-6: Application For Radiation Material Use In AnimalsR | This form is to be used for new researchers wishing to use radioactive materials in animals | Radiation Safety | 919-515-2894 |
| RS-7: Radioactive Material Package Receipt Information | Form used to certify that radioactive materials are properly classified, described, packaged, marked and labeled, and are in proper condition for transportation | Radiation Safety | 919-515-2894 |
| RS-8: Radioactive Material Log of Use | This form will be issued with every primary vial of unsealed radioactive material | Radiation Safety | 919-515-2894 |
| RS-9: Laboratory Contamination Survey Record | This form may be used for monthly contamination surveys in the laboratory | Radiation Safety | 919-515-2894 |
| RS-10A: CVM VTH Radiation Producing Device Authorization Form | This form should be used for research involving animals and radiation-producing devices within the College of Veterinary Medicine | Radiation Safety | 919-515-2894 |
| RS-10A: CVM VTH Radiation Producing Device Authorization Form;/a | This form should be used when acquiring radiation-producing devices | Radiation Safety | 919-515-2894 |
| RS-11: Pregnancy Declaration, Instruction & Dosimetry Evaluation | This form is used to formally declare a pregnancy to the Radiation Safety Office through voluntary means. Other paperwork and further consultation may be required at that time. | Radiation Safety | 919-515-2894 |
| RS-12: Radiation Safety Administrative Amendment | Form used to indicate a charge of status for principal Investigators | Radiation Safety | 919-515-2894 |
| Safety Feature Evaluation of Safety Syringes | Form to document annual review according to the OSHA bloodborne pathogens standard if listed in your BBP Exposure Control Plan. | Biosafety | 919-515-6858 |
| Safety Self-Assessment Checklist | This checklist is a tool to aid the supervisor and their employees in identifying those activities and conditions that need attention to achieve and maintain a safe work environment | Lab Safety | 919-515-6860 |
| Sample Biological Inventory | Use this form to maintain a formal inventory of all biological material received and sent | Biosafety | 919-515-6858 |
| Shipping Declaration Papers For Dangerous Goods | Guidance/example shipping forms for dangerous/hazardous materials | Lab Safety | 919-515-3695 |
| Skin Protection in Laboratories | Yes/No form for analyzing skin protection needs in a laboratory | Lab Safety | 919-515-1282 |
| Stormwater Exposure Management Program Annual Facility Evaluation and Certification | Yearly program that ensures proper stormwater management for a given facility | Environmental Affairs | 919-515-6859 |
| Volunteer Workers Involved In Field, Laboratory, or Teaching Activities | Contains the release of lability and waiver claim, and outlines the proper training requirements | Lab safety | 919-515-6860 |
| Weekly Inspection LogWaste - Weekly Inspection Log | WEEKLY INSPECTION LOG CENTRAL ACCUMULATION AREA | Environmental Affairs | 919-515-6859 |
| Waste management plan | Environmental Affairs | 919-515-6859 | |
| Designer Waste Information FormWaste type form | Environmental Affairs | 919-515-6859 |