ESH Forms
| Beryllium Inventory Form |
| Hepatitis B Vaccine Offer and Declination Form |
For current forms and templates, please see: CoHE Safety Program > Document Library > Forms And Templates
| Air Quality: Emissions Source Inspection Form | PDF | Word |
| Air Quality: Monthly Hazardous Material Use, Fuel Consumption, and Equipment Operation Forms | PDF | Word |
| Chain of Custody Form (general) | Excel |
| Container and Collection Area Weekly Inspection Checklist (Hazardous Waste) | |
| Hazardous Waste Determination Form - See Radiation Forms | |
| Hazardous Waste Pick-Up and Empty Container Request Form | |
| Hazardous Waste Pick-Up and Empty Container Request Instructions | |
| NEPA: Environmental Compliance Checklist | Word |
| Spills Report Form Radioactive Material Management Area (RMMA) Hazardous Material Pickup Request: Call Ext. 2479 | PDF | Word |
Stormwater
| Stormwater: General Inspection Checklist | |
| Stormwater: Contained Water Release Form | |
| Stormwater: Erosion and Sedimentation Control Plan Form | PDF | Word |
| Elevated Surface Work Plan |
| Fixed Ladder Inspection Checklist | |
| Portable Ladder Pre-Use Inspection Checklist | |
| See also ladder safety procedures and tools, including: | |
| - Using Portable Ladders Safely |
| Inspection Checklist |
| Site Access Portal | online |
| Facilities Service Request | online |
Salvage Form
| link |
| SLAC SU-17A - Employee First Report of Injury (also available from the SLAC Occupational Health Center) | Word |
| (related form) First Report of Incident (also listed under Incident Investigation) | online |
Ergonomics
| Industrial Ergonomics Screening Checklist |
Safe Office Moves
| Steps for Safe Office Moves | |
| New Office Safety and Ergonomics Checklist | |
| Safe Office Moves Checklist for Supervisors | |
| see the Safe Office Moves webpage for more information and tools, including a slideshow |
| Authorization to Release Occupational Exposure Information | |
| Declaration of Pregnancy Form | |
| - Withdrawal of Declaration of Pregnancy Form | |
| Dosimeter/ID Request Form A (standard form, w/ESH training) - internal online form - if off-site, requires VPN access - Alternate Hardcopy [pdf] | online |
| Dosimeter/ID Request Form B (no training, limited work in SAA) - internal online form - if off-site, requires VPN access - Alternate Hardcopy [pdf] | online |
| Dosimeter/ID Request Form C (for tours in SAA) | |
| Dosimeter-Lost/Damaged Form | |
| Hazardous Waste Determination Form | |
| Mixed Waste Generation Checklist | |
| Mixed Waste Generation Request Form | |
| Mixed Waste Potential Items List | online |
| Non-DOE Assignment Notification Form | |
| Radiological Issue Report (RIR) Form | online |
| Radioactive Material Declaration Form | |
| Radioactive Survey Request | online |
| Radiation Generating Device (RGD) Registration Form for I-IV | online |
| Radiological Work Permit (RWP) - internal online form - if off-site, requires VPN access | online |
| RP Walk-Through Inspection/Assessment Reports | online |
| Salvage Form (non-ESH Form: SCM Property Control: Surplus ) To be used with ESH Radiological Survey. If Salvage is Radioactive, use with Radioactive Material Declaration Form | link |
| Sealed Radioactive Source Acquisition Authorization Form |
| BIO Project Review Database | online |
| Injury and Illness Prevention Program Acknowledgement Form | |
| Subcontractor Safety Qualification Form | |
| Subcontractor Safety Qualification Evaluation Form | |
| Site-specific Safety Plan Content and Approval Form | |
| Subcontractor Safety Staff Needs Assessment Form | |
| Subcontractor Safety SharePoint Site | online |
| Work Classification Form (Green or Assessment) | online |
| RG-2 and RG-3 Approval to Operate Form |
| Activity Training and Authorization Form | PDF | Word |
| Hazard Evaluation and Planning eTool | online |
| Job Safety Analysis Form | PDF | Word |
| SOP Authorization and Release Form | PDF | Word |
| Term Release Tool | online |
| Work Integration Plan Form | |
| Non-construction Tailgate/Pre-job Release Form | PDF | Word |
| Construction Job Safety Analysis Form | PDF | Word |
| SLAC Receipt of Subcontractor Form | |
| Construction Pre-job Briefing Checklist | |
| Construction Tailgate/Pre-job Release Form | PDF | Word |
| Stop Work Form | PDF | Word |
Area Hazard Analysis Procedure
| Area Hazard Analysis eTool | online |
See the Work Planning and Control Website for more forms and references
