Forms

  • Laboratory Safety Plan
    Laboratory Safety Plan: Includes Schedule F: Biological Hazards; Schedule G: Registration of Recombinant DNA Experiments; Schedule H: Use of Transgenic Animals or Plants
  • Select Agent Destruction Form
    Contact EHS to verify the destruction procedure and arrange for an EHS witness. Complete this form for the final destruction of your Select Agent or Toxin stocks.
  • Required Entryway Sign for BSL-2 Labs
    Sign must be printed on a color printer and contact information completed in entirety. Contact EHS for alternative sizes.
  • IBC Registration Forms
    Schedule G (Registration of Recombinant DNA Experiments), Schedule H (Use of Transgenic Animals or Plants), and Appendix 10-A (Registration of Human Gene Transfer Experiments) and information on completing and submitting the forms.
  • Entryway Sign for ABSL-1 Labs
    Entryway sign.
  • Entryway Sign for ABSL-2 Labs
    Entryway sign.

  • Computer Self-Inspection Check List
    To perform a self-inspection of your workstation refer to the section “Computer Workstation Ergonomics” of your Workplace Safety Employee Handbook. If possible, make appropriate adjustments to your workstation, for each “No” answer as you perform the inspection. If additional assistance is needed, please check the HSO follow-up requested column.

  • Asbestos Inspection Request Form (forms located in the “Attachments” section of the policy)
    UNC-CH Architectural & Engineering Services Asbestos Inspection Request Form
  • Indoor Air Quality Policy (forms located in the “Attachments” section of the policy)
    • Request for Indoor Air Quality Investigation
      Complete this form if you would like EHS to make an initial assessment of indoor air quality in your workplace.
    • Evaluation of Illness Believed Related to Indoor Air Quality at Work
      Refer to the policy section “Employees with Continuing IAQ Complaints” for the proper use of this form.
  • IAQ Diary
    Save this spreadsheet to your computer and fill it out over the month. When it is complete, send the file to David Catalano.
  • Lead-Containing Paint Inspection Request Form
    UNC-CH Architectural & Engineering Services Lead-Containing Paint Inspection Request Form
  • SDS Request Form
    Safety Data Sheet (SDS) Request Form
  • Recurring Odor Complaint
    Recurring odor complaint form
  • Request for Medical Consultation or Examination
    Complete if you believe you have been over-exposed to a hazardous substance in the lab, or if you develop signs and symptoms associated with exposure to a hazardous substance.
  • Request for Monitoring
    Request for monitoring exposures to chemicals in the workplace.
  • Safety Clearance Form
    Safety Clearance Form for laboratory equipment that is to be repaired or moved, or laboratory facilities that have been vacated. For surplus property, use the self-adhesive orange labels available from EHS.
  • Confined Space Entry Form
    Complete this form prior to entering confined spaces. This form will provide valuable information to EHS and local emergency service providers.

  • Laboratory Safety Plan
    On-Line Laboratory Safety Plan
  • IBC Registration Forms
    Schedule G (Registration of Recombinant DNA Experiments), Schedule H (Use of Transgenic Animals or Plants), and Appendix 10-A (Registration of Human Gene Transfer Experiments) and information on completing and submitting the forms.
  • Instructions for Laboratory Worker Registration Form
    All laboratory personnel are required to register with EHS. Read instructions then complete on-line registration form.
  • Laboratory Worker Registration Form
    On-Line Lab/Radiation Worker Registration Form
  • LSM Appendix 5-B
    Glove selection chart.
  • Laboratory Closeout Procedure Checklist (forms located in the “Attachments” section of the policy)
    This form is to guide laboratory personnel when laboratory operations are moved or discontinued. Other requirements may apply.
  • SDS Request Form
    Safety Data Sheet (SDS) Request Form
  • Request for Monitoring (see attachment at bottom of policy)
    Request for monitoring exposures to chemicals in the workplace.
  • Request for Medical Consultation or Examination (see attachment at bottom of policy)
    Complete if you believe you have been over-exposed to a hazardous substance in the lab, or if you develop signs and symptoms associated with exposure to a hazardous substance.
  • Research Animal Handlers Questionnaire
    On-Line form for laboratory workers that handle research animals.
  • Safety Clearance Form
    Safety Clearance Form for laboratory equipment that is to be repaired or moved, or laboratory facilities that have been vacated. For surplus property, use the self-adhesive orange labels available from EHS.
  • Self Inspection Checklist (see attachment at bottom of policy)
    The items on this checklist are some of the most frequent causes of preventable laboratory accidents, and frequently cited by EHS during lab inspections. Contact EHS with any special concerns that arise from these self-audits, and repeat audits frequently in order to track whether your lab is making improvements.

  • Radiation Safety Manual
    Radiation Safety Manual for Authorized Users and Radiation Workers
  • Appendix B
    Lab/Radiation Worker Registration Form (Use electronic version if possible.)
  • Appendix C (forms located in the “Attachments” section of the policy)
    Certification of Current Inventory for Purchase of Radiation Sources
  • Appendix D (Daily Inventory Log) (forms located in the “Attachments” section of the policy)
    Authorized User’s Radioactive Materials Inventory Record, EHS Forms 501
  • Appendix F (Safety Clearance Form) (forms located in the “Attachments” section of the policy)
    Safety Clearance Form for laboratory equipment that is to be repaired or moved, or laboratory facilities that have been vacated. For surplus property, use the self-adhesive orange labels available from EHS.
  • Appendix H
    Contamination Survey Procedures
  • Appendix I (forms located in the “Attachments” section of the policy)
    Radiation Safety Security Procedures
  • Human Use of Radiation in Research
    Application for Human Use of Radiation in Research
  • Laboratory Closeout Procedure (forms located in the “Attachments” section of the policy)
    This form is to guide laboratory personnel when laboratory operations are moved or discontinued. Other requirements may apply.
  • Laboratory Safety Plan
    Laboratory Safety Plan: Includes Schedule C: Radioactive Materials; Schedule D: X-Ray Equipment; Schedule E: Lasers
  • Instructions for Laboratory Worker Registration Form
    All laboratory personnel are required to register with EHS. Read instructions then complete on-line registration form.
  • Laboratory Worker Registration Form
    On-Line Lab/Radiation Worker Registration Form
  • Notice to Employees
    This North Carolina Radiation Protection Section’s form (in 8.5″ X 14″ format) must also be posted in each room authorized for the use of radioactive materials.
  • Postings
    Pages 11, 20, and Appendix I of the Radiation Safety Manual (in 11″ X 17″ format) which must be posted in each room authorized for the use of radioactive materials
  • Radionuclide Characteristics
    Characteristics of Commonly Used Radionuclides
  • Vacating Lab Space
    Procedure for Vacating/Moving Laboratory Space

  • Employee Accident Report Form
    This form is to be completed by the employee and forwarded to EHS as soon as practicable after the injury.
  • Supervisor Accident Report Form
    This form is to be completed by the Supervisor and forwarded to EHS along with a copy of the NCIC Form 19 as soon as practicable. All incidents involving serious bodily injury or death must be reported to EHS immediately.
  • NCIC Form 19
    North Carolina Industrial Commission’s Form 19. Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission.
  • Form 18
    Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for Workers’ Compensation Benefits