Florida State University Environmental Health & Safety

EHS / Forms

General Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 1-2	Request for Approval of a Temporary Food Event

Insurance and Workers' Compensation Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 2-1	General Liability Loss Report
				EHS 2-2	Building Insurance Request Form
				EHS 2-4	Insurance Request Form
				EHS 2-6	Incident Report
				EHS 2-7	Camp Insurance Request Form
				EHS 2-9	Automobile Accident Report
				EHS 2-11	General Liability Claimant Checklist
				EHS 2-12	Automobile Claimant Checklist
				EHS 2-13	Building Deletion Form
				EHS 2-14	Golf Cart, Utility Vehicle and All-Terrain Acknowledgement Form
				EHS 2-15	Golf Cart, Utility Vehicle and All-Terrain Vehicle Annual Safety Inspection Checklist
				EHS 2-16	Lien Disclosure Statement
				EHS 11-1	First Report of Injury or Illness (AKA Notice of Injury)
				EHS 11-2	Accident Investigation Report
				EHS 11-3	Request for Taxpayer Identification Number and Certification (IRS W-9)

Fire Safety Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 3-1	Fire Alarm Report
				EHS 3-2	Fire/Emergency Evacuation Drill

Industrial Hygiene Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 4-1	Confined Space Entry Permit
				EHS 4-2	Entering Permit-Required Confined Spaces Using Alternate Procedures
				EHS 4-3	Reclassifying a Confined Space Form

Building Code Administration Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 5-1	Building Code Permit Application
				EHS 5-2	Document Review Request
				EHS 5-3	Inspection Request/Report Form
				EHS 5-4	Letter of Authorization to Sign for Permits
				EHS 5-5	Permit Checklist
				EHS 5-6	Occupancy/Completion Checklist Form
				EHS 5-7	Product Approval Specification Sheet

Research Support Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 6-1	Principal Investigator Registration Form
				EHS 6-2	Registration to Use SCUBA Diving in Research Form

Biological Safety Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 7-1	Select Agents Registration Form
				EHS 7-2	Medical Monitoring for Vertebrate Animal Users Form
				EHS 7-3	Hepatitis B Vaccine Record
				EHS 7-4	Exposure Determination Worksheet
				EHS 7-5	Biomedical Waste Disposal Form
				EHS 7-6	Etio/Select Agents Registration Update Form
				EHS 7-7	Recombinant DNA Registration Update Form
					Appendix B
					Appendix B Instructions
					Biological Safety Level 2 Checklist
					Biological Safety Level 2 De-posting Checklist

Chemical Safety Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 8-2	Hazardous Waste Pickup Request Form
				EHS 8-3	Hazardous Materials Registration Update Form

Laboratory Safety Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 8-1	Chemical Inventory
				EHS 9-1	Controlled Substance Request for Registration Information
				EHS 9-2	Security Screening Form
				EHS 9-3	Employee Questionnaire for Controlled Substance Access
				EHS 9-4	Controlled Substance Order/Receipt Record
				EHS 9-5	Controlled Substance Use Log
				EHS 9-6	Controlled Substance Spill Record
				EHS 9-7	Laboratory Inspection Guide
				EHS 9-8	Drug Order Worksheet
				EHS 9-9	Prescription Drug Registration
				EHS 9-10	Prescription Drug Receipt
					SOP Template for Hazardous Experiments

Radiation Safety Forms

Format				Form Number	Form Name
web*	xls	doc	pdf	Form Number	Form Name
				EHS 10-1	Proposal to Use Radioactive Materials
				EHS 10-2	Authorized Users for Radioactive Materials
				EHS 10-3	Personnel Dosimetry Application
				EHS 10-4	Radioactive Waste Disposal Form
				EHS 10-5	Laser Registration Form