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Environment, Health & Safety Forms

Use these forms to communicate required information to Environment, Health & Safety.

Use the data table below to find links to EH&S forms. See additional tips for using data tables. Use the Filter box and type in a category or form name. Some browsers may not allow you to fill in PDF forms; please use Chrome or IE when possible.

Category Form Name (online link) PDF link Excel/ Word file link
Animal exposure / Vivarium Form A – Risk Assessment Work Evaluation Questionnaire for Employees or Affiliates with Animal Contact PDF
Animal exposure / Vivarium Form B – Medical History Questionnaire for Employees or Affiliates with Animal Contact PDF
Asbestos Asbestos Project Information Sheet
Biosafety Biosafety Forms
Confined space Confined Space Entry Permit PDF
Confined space Routine Confined Space Entry Log PDF
Controlled Substances PSDS- Applicant (for CSUA Lab Contacts and Authorized Personnel) PDF
Controlled Substances PSDS- Principal Investigator (for Principal Investigators only) PDF
Controlled Substances CS Self-Assessment Audit Sheet PDF
Controlled Substances CS Usage Log (sample) PDF
Controlled Substances CS Usage Log (additional page) PDF
Controlled Substances CS Usage Log (for solutions only) PDF
Controlled Substances Deactivation of Controlled Substances Use Authorization PDF
Environmental protection & pollution prevention Environmental Compliance Assurance Form
Environmental protection & pollution prevention Petroleum Container Inspection Checklist PDF Word
Environmental protection & pollution prevention Refrigerant: Contractor Input PDF Word
Environmental protection & pollution prevention Refrigerant: Cylinder Input PDF Word
Environmental protection & pollution prevention Refrigerant: Equipment Input PDF Word
Environmental protection & pollution prevention Refrigerant: Recover/ Recycling Unit Input PDF Word
Environmental protection & pollution prevention Refrigerant: Service Order PDF Word
Ergonomics Ergonomic Resources Fund Request

Fire and life safety Fire Inspection Form PDF
Emergency preparedness/ first aid kits Obtain and restock a research laboratory first-aid kit
Emergency preparedness/ first aid kits First Aid Kit approved list for UCSD PDF
Food facility temporary permit applications Off-Campus / Commercial Temporary
Food Facility Permit Application
Food facility temporary permit applications On-Campus / Non-Profit and Student Organizations
Temporary Food Facility Permit Application
Hazardous waste Online Waste Tag Program (OTP)
Hazardous waste Hazardous Waste Generator Number Application
Heat Illness Prevention Program Compliance Checklist PDF Word
Heat Illness Prevention Program Worksite Specific Procedures PDF Word
Hot Work Program Hot Work Permits PDF
Hot Work Program Activity Logs PDF Word
Injury & Illness Prevention Program (IIPP) Accident Investigation (how and why it happened) PDF Word
Injury & Illness Prevention Program (IIPP) Campuswide IIPP Program document (contains all IIPP forms) PDF Word
Injury & Illness Prevention Program (IIPP) Custodial Storage Area Inspection Checklist (for HDH) PDF
Injury & Illness Prevention Program (IIPP) Dining Facility Safety Inspection Checklist PDF
Injury & Illness Prevention Program (IIPP) Employee Safety Recommendation PDF Word
Injury & Illness Prevention Program (IIPP) Environment of Care / Patient Safety Rounds Tool PDF
Injury & Illness Prevention Program (IIPP) Hazard Identification PDF Word
Injury & Illness Prevention Program (IIPP) New Laboratory Worker Checklist PDF Word
Injury & Illness Prevention Program (IIPP) Office Safety Inspection PDF Word
Injury & Illness Prevention Program (IIPP) Shop & Studio Safety Inspection Report PDF Excel
Injury & Illness Prevention Program (IIPP) Shop & Studio Safety Inspection Checklist PDF Excel
Injury & Illness Prevention Program (IIPP) Supervisor's Safety Meeting PDF Word
Ladder and lifts safety Ladder inspection form PDF
Laser safety Laser Safety Forms
Lead-Based Paint Management Program Lead-Based Paint Project Information Sheet
Lockout/ Tagout LOTO Training form PDF
Lockout/ Tagout LOTO Use forms PDF
Personal protective equipment (PPE) PPE Hazard Assessment (non-research) English, Spanish
Personal protective equipment (PPE) Embroidered Lab Coat Fitting Form
Personal protective equipment (PPE) Lab Coat Laundry Envelope Request Form
Personal protective equipment (PPE) Additional PPE Request Form
Personal protective equipment (PPE) Undelivered or Missing Lab Coats
Pest Control Request Pest Control Services PDF
Pest Control Residential apartments and halls: EH&S Pest Management Preparation List PDF Word
Radiation safety Radiation Safety Forms: Health System Employees
Radiation safety Radiation Safety Forms: Research Employees
Report a Safety Concern to EH&S Report a Safety Concern
Work-Related Injury, Illness, or Exposure Student and Visitor Incident Report
Work-Related Injury, Illness, or Exposure Employee's Occupational Incident Report
Work-Related Injury, Illness, or Exposure Supervisor's Occupational Incident Report
Research safety Chemical Abbreviations and Annotations PDF Word
Research safety Controlled Substances - see the Controlled Substances section above
Research safety Decontamination Clearance Request
Research safety Environmental Compliance Assurance Form
Research safety First Aid Kit approved supplied list PDF
Research safety First-Aid Kit: Obtain and Restock Form
Research safety Laboratory Hazard Assessment Tool (LHAT) PDF Word
Research safety Laboratory Relocation or Closure Notification
Research safety Magnet Registration PDF Word
Research safety New Laboratory Worker Checklist PDF
Research safety Principal Investigator Information PDF
Research safety Minors in Lab Packet  PDF
Research safety Lab Self-Audit Form PDF
Respiratory protection Hazard Evaluation - For Respirator Use Request
Respiratory protection Medical Evaluation Questionnaire for Respirator-Use Certification PDF Word
Risk management (liability insurance) Risk Management Forms
Safety Award For Excellence (SAFE) Safety Award For Excellence (SAFE) form
Special events Special Events Checklist Tool - On-Campus Events PDF
Workers' compensation Designation of Physician PDF
Workers' compensation Employee's Occupational Incident Report
Workers' compensation Supervisor's Occupational Incident Report
Workers' compensation Incident Report for Students & Visitors 
Workers' compensation OSHA Form 300A: Summary of Work-Related Injuries and Illness
Workers' compensation Transitional Return to Work Program Guidelines PDF Word