Environmental Health & Safety Forms

Forms and Required Permits

EH&S Forms | MacroTechnology Forms | Radiation Safety Forms

Form Name Description Format
Environmental Health & Safety
Accident/Near Miss/Quality Improvement Reports This form is to be filled out anytime there is an accident (vehicle, injury or property loss) or near miss (potential for accident) involving ASU facilities or property whether or not a claim is filed.

WEB FORM - ASU

WEB FORM - NON

Bloodborne Pathogens This form is to be filled out for any person working with blood, human fluids or tissues who does NOT want Hepatitis B vaccine. After signing it should be filed with the PI or supervisor along with the training record.

PDF - Hep B

PDF - Bloodborne Pathogen

Confined Space Entry - Except MacroTechnology Works A permit is required to enter a confined space that may have a hazardous atmosphere or contains recognized serious safety or health hazard. See ASU’s Confined Space Entry Plan for more information.

PDF - Entry

PDF - Pre-Entry Checklist

Fire Safety
Events Permit Application
An Events Permit Application must be filled out and submitted to ASU EH&S/Fire Marshal two weeks prior to the event. For more information see Special events Compliance Guidelines.
Fire Safety Self Inspection  
Indoor Air Quality (IAQ) This form is to be used if you have concers about indoor air quality at ASU.
Indoor Air Quality - Asbestos This form is to be used to request removal , repair, encapsulation, testing or evaluation for known or suspected asbestos contamination.
Laboratory Safety

Chemical Inventory Template

Prior Approval Form

Responsible Party Information Sheet

These templates are provided to keep track of the chemicals currently in the laboratory. Before obtaining a New Hazardous Chemical a prior approval form must be filed with EH&S.

The Responsible Party Information Form is for lab registration.

Personal Protective Equipment (PPE)

Certificate of Hazard Assessment

Training Verification

All managers and supervisors must survey the work areas and activities under their control to determine where PPE may be required.
Personal Protective Equipment (PPE)

Chemical Resistant Gloves

These guides can be used to help determine the manufacturer and model of glove that will provide adequate skin contact protection during chemical use.
Personal Protective Equipment (PPE)

University Services Respirator Evaluation Instructions

Non-University Services Respirator Evaluation Instructions
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Respirator Evaluation Instructions for University Services and non-University Services personnel.
MacroTechnology Works
Chemical Approval This procedure defines the process for requesting an approval for use of new chemical materials at ASU’s MacroTechnology Works
 PDF - Process
PDF - Form
Chemical Handling and Personal Protective Equipment - Safety Glasses This is the procedure for obtaining perscription safety glasses at ASU as described in FDC Chemical Handling and Personal Protective Equipment.

PDF - Safety Requirements

PDF - Safety Glasses

Chemical Inventory ASU MTW maintains on-site chemical inventories below the Screening Threshold Quantities (STQ) for all chemicals listed in DHS - COI Appendix A
Security Access This is to request access to ASU MacroTechnology Works

PDF - ASU

PDF - Non ASU

Confined Space Entry Permit - MTW MacroTechnology Works has a separate Confined Space Entry Procedure.
Hazard Communication The MTW Hazard Communication Checklist is to be used to make sure the Hazard Communication Standard is followed.

PDF - Standard

PDF - Checklist

PDF - Waste Pickup

Non Emergency Incident

An incident that arises that does not constitute an emergency but additional assistance is necessary, e.g.an odor in the work area.
Radiation Safety
Laser RegistrationLasers must be registered within 30 days of arrival on campus whether or not they are used.
Laser Control Area This permit is necessary for anyone working at or visiting ASU who procures or uses Class IIIb or IV lasers.
Laser Safety Training This class is for anyone working at or visiting ASU who uses Class IIIb or IV lasers. Prior to taking this class the user must have a base line eye exam.
Radio Active Material Sub- License Application The use of radioactive materials at ASU requires an appropriate sub-license or permit issued by the Radiation Safety Office.
Radioactive Material (RAM) Training This class is required for people working at or visiting ASU who procure, use or dispose of radioactive materials.
Source Utilization Use this form to keep track of use of radioactive chemicals.
Radiation Producing Equipment (RPE) License An RPE license must be obtained before registering any RPE material or equipment.
Analytical X-Ray This form may be used for registering any type of regulated radiation producing equipment.
Radiation Producing Equipment (RPE) Training
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This class is required for people who want to procure, or need access to ionizing radiation producing equipment