Forms

Online Request Forms

• Dosimetry - Request a Dosimeter or submit a request for a Dosimeter update on the EHS Safety Portal (Dosimeter Request).  The following requests can be submitted:
  • Request a Dosimeter (X-ray Users and VMC Users)
  • Change Personal Information
  • Report a Lost Dosimeter
  • Discontine a Dosimeter
• Waste Pickup - Request a waste pickup on the EHS Safety Portal.  The following requests can be submitted:
  • Hazardous Waste Pickup
  • Incineration Pickup
  • Radioactive Waste Pickup
• Laboratory Labels - Request laboratory labels on the EHS Safety Portal (Lab Label Request).
• Laboratory Door Sign Request - Request laboratory signs on the EHS Safety Portal (Lab Door Sign Request).
• Radioactive Materials Order - Request radioactive materials on the EHS Safety Portal (PI Portal).
• Radioactive Waste Pickup - Request a Rad Waste pickup on the EHS Safety Portal.

Aerial Lift & Fall Protection

• Site-Specific Training Checklist - for use with all aerial work platforms: DOC | PDF
• Site-Specific Training Checklist - for use with aerial work platforms that require personal fall protection: DOC | PDF

Biological Safety

• Autoclave Testing Checklist for New Autoclaves (PDF)
• Autoclave Testing Checklist for Repeat Testing (PDF)
• Biological Risk Assessment Form (PDF)
• Biological Inventory Template (DOCX)
• Click - External Team Members (DOCX)
• Click - MSU Flow Cytometry Core Cell Sorting Addendum (DOCX)
• Click - Summary of Recombinant DNA/Bioengineering Research (DOCX)
• Equipment Release Form (PDF)
• Task Procedure Example Form (DOCX)

Biological Safety Site-Specific Training Checklists

• Laboratory/General Site-Specific Safety Checklist (PDF)
• Veterinary Diagnostic Lab (PDF)
• Veterinary Medical Center (PDF)

Bloodborne Pathogens

• Hepatitis B Vaccination Form (PDF) (Occupational Health website)
• Safer Sharps Device Evaluation Form (PDF)
• Safer Sharps Devices Annual Review Form (DOC)
• Site Specific Training Checklist (PDF)
• Site Specific Training Checklist: Supervisor's Guidelines (PDF)
• Sharps Injury Log (PDF)
• Source Patient Lab Worksheet (PDF)
• Source Patient Protocol (PDF)
• Task Procedure Form (DOCX)

Chemicals and General Laboratory Safety

• Chemical & Biological Lab Inspection Form (PDF)
• Equipment Release Form (PDF)
• Eyewash Test Log (PDF)
• Hazardous Drugs Inventory (XLSX)
• Laboratory Access Log (PDF)
• Laboratory Clearance Checklist (PDF)
• Laboratory Door Sign Request - Request laboratory signs on the EHS Safety Portal (Lab Door Sign Request).
• Laboratory Hazardous Materials Log (PDF)
• Laboratory Labels - Request laboratory labels on the EHS Safety Portal (Lab Label Request).
• Laboratory/General Site-Specific Safety Checklist (PDF)
• Laboratory SOP, Blank (DOCX)
• Laboratory SOP, Templates
• Minors in Laboratories Consent/Certification Form (PDF)

Confined Spaces & Hot Work

• Confined Space Entry Form (PDF)
• Hot Work Permit (PDF)
• Identification and Classification Form: DOC | PDF
• Reclassification of Permit to Non-permit Space: DOC | PDF

Construction Safety

• Contractor Incident Reporting Form (PDF)
• MSU Construction Safety Statistics Report: XLSX | PDF

Controlled Substances

• Annual Inventory Form (PDF)
• Authorized Agent Log (PDF)
• Authorized Agent Questionnaire (PDF)
• Diluted Solution Usage Form (PDF)
• General Inventory Form (PDF)
• Initial Inventory Form (PDF)
• Multiple Dose Usage Form (PDF)
• Self Audit Checklist (DOCX)

Hand Tools

• Power and Hand Tool Regulations Checklist:  DOC  |  PDF

Hazard Communication (Right-to-Know)

• Department Training Plan Template:  DOC |  PDF
• Certification of Employee Hazard Communication Training:  DOC |  PDF

Human Materials

• Biological Inventory (XLSX)
• Safer Sharps Evaluation Form (PDF)
• Safer Sharps Annual Review Form (DOC)
• Laboratory/General Site-Specific Safety Checklist (PDF)
• Source Protocol (PDF)
• Task Procedure (DOCX) (Standard Operating Procedure)

Ladders

• Ladder Inspection Checklist:  DOC  |  PDF

Lasers

• Corrective Action Sheet (PDF)
• Hazard Evaluation Form (PDF)
• Laser Inventory Input Form on the EHS Safety Portal (PI Portal).
• Inspection Form (PDF)
• Purchase / Transport Request (PDF)
• Safety Census Form (PDF)
• Self Audit Checklist (PDF)
• Laboratory/General Site-Specific Safety Checklist (PDF)
• Standard Operating Procedure (SOP) Form (DOC)

Lockout/Tagout

• Partial Exception Worksheet: DOC |  PDF

Personal Protective Equipment (PPE)

• PPE Hazard Assessment Certification Forms, Blank: DOC | PDF
• PPE Hazard Assessment Certification Forms, Sample Forms: DOC | PDF
• PPE Survey and Analysis Form (PDF)
• PPE Training Certification Form (PDF)

Powered Industrial Trucks (Forktrucks)

• MSU Performance Test:  DOC | PDF
• Daily Inspection Checklist Gas:  DOC |  PDF
• Daily Inspection Checklist Electric:  DOC |  PDF

Radioactive Materials

• Declaration of Pregnancy for Radiation Workers (DOCX)
• Declaration of Principal Investigator Absence - Radiation Producing Equipment 
• Declaration of Principal Investigator Absence - Radioactive Materials
• Dosimetry - Request a Dosimeter or submit a request for a Dosimeter update on the EHS Safety Portal (Dosimeter Request).  The following requests can be submitted:
  • Request a Dosimeter (X-ray Users and VMC Users)
  • Change Personal Information
  • Report a Lost Dosimeter
  • Discontine a Dosimeter
• Equipment Release Form (PDF)
• Rad Materials Order - Request radioactive materials on the EHS Safety Portal (PI Portal).
• Rad Survey Form (PDF)
• Rad Use Log (PDF)
• Laboratory/General Site-Specific Safety Checklist (PDF)

Tractors and Farm

• Performance Evaluation Checklist for Tractor Operators: DOC | PDF
• Tractor Operator Implement Training Documentation: DOC | PDF

Waste Pickup

• Waste Pickup - Request a waste pickup on the EHS Safety Portal.  The following requests can be submitted:
  • Hazardous Waste Pickup
  • Incineration Pickup
  • Radioactive Waste Pickup