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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
Anesthesia SOP

To use anesthesia at ASU you must have a Standard Operating Procedure (SOP) for isoflurane. Two forms are provided the pdf form is an example and the doc form is a SOP Template for you to adapt for your individual anesthesia apparatus.

SOP FORM - PDF

SOP FORM - WORD
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 This form is to help with developing emergency plans.

Hazardous Waste
Pick-up Request

 Use this form when requesting a pick-up of hazardous material from campus locations.

WEB FORM
Indoor Air Quality (IAQ) This form is to be used if you have concers about indoor air quality at ASU.
PDF or WORD
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

Training Record

NFPA Chemical Labels

Parental Permission Form

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.

Template for managers to keep track of employees safety training.

NFPA Labels template, for use with Avery 5160 type label, use to label chemicals in Laboratories.

Permission for minors in the laboratory use the Parental Permission Form and modify it for the current situation.
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.

WORD or PDF

WORD or PDF
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.

PDF - University Services

PDF - Non-University Services

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
Radiation Safety
Laser Registration Lasers 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.
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
return to top		 This class is required for people who want to procure, or need access to ionizing radiation producing equipment