Special Resources » Forms: Environmental Health & Safety
Download forms for workplace safety and health. Examples: job hazard analysis forms, confined entry permit form, TRI forms, building evacuation plan form, JCAHO medical errors reporting form, ergonomics cost / benefit form, etc.
The following is the collection of special resources throughout the library. Click on main category / sub-category for that section of the library OR Click on resource title for immediate access to the resource.
Accident/Illness Reporting and Recording Procedures & Forms ![[pdf]](graphics/file_pdf.gif)
[18903]
Sample procedures and forms in use by a US government agency
[18903] Sample procedures and forms in use by a US government agency
Truck Driver Accident Interview Form [27829]
Includes sections on crash data information, rollover data, fire data, jackknife data, cargo shift data and more
[27829] Includes sections on crash data information, rollover data, fire data, jackknife data, cargo shift data and more
Agriculture Safety » Farm Machinery Safety
Farm equipment safety, tractor safety, ROPS, baler safety, etc.
Farm equipment safety, tractor safety, ROPS, baler safety, etc.
Biological Safety » Bloodborne Pathogens
Sample bloodborne pathogen plans, BBP program controls and policies, reference m
Sample bloodborne pathogen plans, BBP program controls and policies, reference m
Bloodborne Pathogens Reference and Training Manual [5457]
Workers tutorial with test and training forms on bloodborne pathogens
Workers tutorial with test and training forms on bloodborne pathogens
Chemical Safety » Asbestos Safety
Asbestos control programs, health effects, abatement, technical resources, etc.
Asbestos control programs, health effects, abatement, technical resources, etc.
Asbestos Safety Checklist [18885]
Sample asbestos safety checklist and standard operating procedures
[18885] Sample asbestos safety checklist and standard operating procedures
Chemical Safety » Chemical Hazards
Chemical safety guidelines, NIOSH Pocket Guide, harmful chemical health hazards
Chemical safety guidelines, NIOSH Pocket Guide, harmful chemical health hazards
Chronic Beryllium Disease Prevention Program (CBDPP) [8641]
The text of the Final Rule including the 2006 revision
The text of the Final Rule including the 2006 revision
Compressed Gas Safety Checklist [18894]
Checklists for compressed gas safety, hydrogen safety, cylinder inspections
[18894] Checklists for compressed gas safety, hydrogen safety, cylinder inspections
Chemical Safety » Hazardous Waste
Guides for hazardous waste management, site remediation, waste minimization
Guides for hazardous waste management, site remediation, waste minimization
Hazardous Waste & Environmental Protection [14022]
Full text of a written hazardous waste program in use by a government agency
Full text of a written hazardous waste program in use by a government agency
Complying with OSHA's Hazard Communication Standard [23113]
Includes a sample written hazcom program and forms
Includes a sample written hazcom program and forms
National Institutes of Health Hazard Communication Program [5121]
Full text of the NIH's Hazcomm Program including checklist & form
[5121] Full text of the NIH's Hazcomm Program including checklist & form
Chemical Safety » Poison Prevention
Poison control advice regarding preventing chemical poisoning, plant poisoning
Poison control advice regarding preventing chemical poisoning, plant poisoning
Model Underground Storage Tank Environmental Results Program Workbook [23708]
164-page workbook contains general information about ERP, regulatory requirements, best practices, draft forms
164-page workbook contains general information about ERP, regulatory requirements, best practices, draft forms
Construction Safety » Contractor Safety Manual
Sample construction safety programs, rules, policies, checklists, SOPs
Sample construction safety programs, rules, policies, checklists, SOPs
Trenching And Excavation Operations Checklist [18886]
Sample trenching safety checklist and standard operating procedures
[18886] Sample trenching safety checklist and standard operating procedures
Construction Jobsite Loss Control Survey [26060]
Checklist of safety items that should be observed at construction job sites
Checklist of safety items that should be observed at construction job sites
School Emergency Preparedness Plan & Forms [8864]
This two volume model program can be adapted to the needs of your site
This two volume model program can be adapted to the needs of your site
Environmental Safety » Pollution
Resources to identify technologies & management practices to reduce pollution
Resources to identify technologies & management practices to reduce pollution
TRI - Toxics Release Inventory: Community Right-to-Know [3653]
Very large number of resources, including TRI forms and reporting requirements
Very large number of resources, including TRI forms and reporting requirements
Cranes, Hoists And Slings Checklist [18907]
Sample checklist and safety rules for the use of cranes, hoist and lsings
[18907] Sample checklist and safety rules for the use of cranes, hoist and lsings
Equipment Safety » Equipment Safety
Safety materials on industrial robots, woodworking machinery, machine shops, etc
Safety materials on industrial robots, woodworking machinery, machine shops, etc
Forklift Safety Program [23322]
Text of a safety program for forklifts includes forklift safety forms
Text of a safety program for forklifts includes forklift safety forms
Equipment Safety » Lockout/Tagout
Equipment electrical safety, lockout/tagout programs, preventing electrical shoc
Equipment electrical safety, lockout/tagout programs, preventing electrical shoc
Control of Hazardous Energy Sources Checklist [18889]
Sample lockout/tagout checklist and safety rules
[18889] Sample lockout/tagout checklist and safety rules
Hand and Power Tool Safety Checklist [18904]
Sample checklist and safety rules for the use of hand and power tools
[18904] Sample checklist and safety rules for the use of hand and power tools
Hot Work Permit Program [3334]
Example of a hot work permit program for welding, flame cutting and soldering
[3334] Example of a hot work permit program for welding, flame cutting and soldering
Hot Work Permit Template and Checklist [18879]
Sample hot work permit template, safety checklist and procedures
[18879] Sample hot work permit template, safety checklist and procedures
Ergonomics » Chairs/Sitting Hazards
Chair selection criteria, seated postures, tips on chair adjustment, etc.
Chair selection criteria, seated postures, tips on chair adjustment, etc.
Ergonomic Seating Evaluation Form [19240]
A worksheet to help you gather information on the quality of chairs being assessed
[19240] A worksheet to help you gather information on the quality of chairs being assessed
Ergonomic Keyboard & Mouse Platform Systems Evaluation Form [19241]
Worksheet to help you gather information on the quality of keyboard & mouse platforms being assessed
Worksheet to help you gather information on the quality of keyboard & mouse platforms being assessed
Ergonomic Tape Evaluation [18826]
Checklist of information to be obtained that will accompany the video
Checklist of information to be obtained that will accompany the video
Ergonomic Cost-Justification Worksheets [19239]
Helps you to calculate a return-on-investment (ROI) for an ergonomics intervention
Helps you to calculate a return-on-investment (ROI) for an ergonomics intervention
Prevention and Control of Work Related Upper Limb Disorders [19231]
Example of a management process description
[19231] Example of a management process description
Fire Safety » Electrical Safety
Lock Out/Tag Out Programs and technical reference materials on electrical safety
Lock Out/Tag Out Programs and technical reference materials on electrical safety
Safe Electrical Work Practices Checklist [18888]
Sample checklists and safety rules for electrical safety
[18888] Sample checklists and safety rules for electrical safety
Means of Egress/Escape Self-Inspection Checklist [32558]
Applies to private employers and their employees
Applies to private employers and their employees
Battery Charging and Storage Operations Checklist [18900]
These systems may include lead acid batteries, lithium chloride batteries, and other similar devices
[18900] These systems may include lead acid batteries, lithium chloride batteries, and other similar devices
Flammable & Combustible Liquid Storage Checklist [18901]
Sample checklist and safety rules for safe storage of flammable and combustible liquids
[18901] Sample checklist and safety rules for safe storage of flammable and combustible liquids
Driver's Medical Examination: Fitness to Drive Form [12123]
US DOT medical examination report for commercial fitness determination
[12123] US DOT medical examination report for commercial fitness determination
FMCSA Drive Medical Examination Form [20710]
Download the medical exam form used to determine qualification of CMV drivers
Download the medical exam form used to determine qualification of CMV drivers
AR-Arkansas State Vehicle Safety Program ![[doc]](graphics/file_doc.gif)
[17550]
Point system used for the state's fleet drivers - including sample forms
[17550] Point system used for the state's fleet drivers - including sample forms
NC-North Carolina Forms for Driver License [15893]
The Driver Privacy Protection Act - Form 1 required
The Driver Privacy Protection Act - Form 1 required
Fleet Safety » Fleet Policies
Sample fleet-related company policies - vehicle use, drivers, seat belts, etc.
Sample fleet-related company policies - vehicle use, drivers, seat belts, etc.
MVR Statement [16147]
Sample form that can be signed by a driver acknowledging MVR point system policies
[16147] Sample form that can be signed by a driver acknowledging MVR point system policies
VA-Virginia Office of Fleet Management Services [19671]
Fleet rules and regulations for state agencies in Virginia
Fleet rules and regulations for state agencies in Virginia
DOT Hazardous Materials Documents [3570]
Download format forms & documents from the Office of Hazardous Materials - pdf format
Download format forms & documents from the Office of Hazardous Materials - pdf format
Fleet Safety » Vehicle Inspections
Procedures for inspecting trucks, buses, cargo tanks, etc. Pre-trip inspections.
Procedures for inspecting trucks, buses, cargo tanks, etc. Pre-trip inspections.
Motor Vehicle Safety, Vehicle Inspection & Snomobile Pre-Trip Checklists [18883]
Sample checklists and safety rules for motor vehicle safety, snomobiles and snowcats
[18883] Sample checklists and safety rules for motor vehicle safety, snomobiles and snowcats
Fleet Safety » Vehicle Maintenance
Guidance & checklists for vehicle preventive maintenance procedures
Guidance & checklists for vehicle preventive maintenance procedures
Light Vehicle Preventive Maintenance Checklists [21059]
Series of service checklists based on mileage
Series of service checklists based on mileage
Motor Carrier and Highway Safety Forms and Publications [5733]
Various forms & other guidance documents to help motor carriers achieve compliance
Various forms & other guidance documents to help motor carriers achieve compliance
Health Care Safety » Accreditation
Organizations & their procedures for accreditation of health care facilities
Organizations & their procedures for accreditation of health care facilities
5 Questions - Dentistry Infection Control [32443]
The answers here are derived from recommendations from the CDC, ADA and OSAP
The answers here are derived from recommendations from the CDC, ADA and OSAP
Backflow Prevention and the Dental Operative Unit [32434]
The risk of contamination from cross-connections from the dental operative unit
The risk of contamination from cross-connections from the dental operative unit
Boil-Water Advisories and the Dental Office [32435]
A boil-water advisory is a public health announcement that the public should boil tap water before drinking it
A boil-water advisory is a public health announcement that the public should boil tap water before drinking it
Engineering and Administrative Recommendations for Water Fluoridation [32440]
1995 Centers for Disease Control report
1995 Centers for Disease Control report
HIV Postexposure Prophylaxis by Dental Health Care Personnel [32441]
A study on the use of PEP for exposure to HIV among dental workers
A study on the use of PEP for exposure to HIV among dental workers
Infection Control & Safety in Dentistry FAQ [32433]
Covers waste treatment and disposal, handwashing, practice safety, disease agents, regulatory processes and much more
Covers waste treatment and disposal, handwashing, practice safety, disease agents, regulatory processes and much more
MRSA in the Dental Office [32444]
An overview of the issue of methicillin-resistant staphylococcus aureus (MRSA) infections in dentistry
[32444] An overview of the issue of methicillin-resistant staphylococcus aureus (MRSA) infections in dentistry
Recommendations for Using Fluoride to Prevent & Control Dental Caries [32439]
When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries
When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries
Recommended Infection Control Practices for Dentistry [32438]
Developed for dental health care personnel
Developed for dental health care personnel
Health Care Safety » Disaster Management
Emergency plans and disaster guidance for health care facilities
Emergency plans and disaster guidance for health care facilities
Emergency Department Screening and Isolation Drill Guidance [30056]
Guidance documents for hospital emergency departments
Guidance documents for hospital emergency departments
Healthcare Organizations Nuclear, Biological & Chemical Decontamination [30048]
Summary of Joint Commission's accreditation requirements
Summary of Joint Commission's accreditation requirements
Hospital Disaster Preparedness Guidelines [30051]
Draft guidelines prepared by the State of New York
Draft guidelines prepared by the State of New York
Hospital Treatment Guidelines - Terrorism Agents [30052]
Treament guidelines for hospitals and clinicians on terrorism agents
Treament guidelines for hospitals and clinicians on terrorism agents
Mass Casualty Care Strategy for Biological Terrorism Incidents [30049]
An approach to disaster medical response with mass casualties
An approach to disaster medical response with mass casualties
Medical Center Hazard and Vulnerability Assessment Tool [30046]
Worksheet used to evaluate potential for event and response
Worksheet used to evaluate potential for event and response
Medical Center Hazard Vulnerability Analysis Tool [30047]
Uses a quantitative method to evaluate vulnerability
Uses a quantitative method to evaluate vulnerability
Health Care Safety » Hospital Safety
Sample worker safety programs & guidance on pollution elimination in hospitals
Sample worker safety programs & guidance on pollution elimination in hospitals
Hospital Walk-Around Inspection Checklist [18827]
What to look for when conducting an inspection of a hospital
What to look for when conducting an inspection of a hospital
Medical Center Safety Manuals [3304]
Download full text of 4 safety manuals and numerous forms - Microsoft Word format
Download full text of 4 safety manuals and numerous forms - Microsoft Word format
Insurance Loss Control » Construction Insurance
Risk management and insurance related issues in the construction industry
Risk management and insurance related issues in the construction industry
Fire Safety Construction Requirements [19406] Full text of a safety policy & procedure that can be used when renovating existing structures
Insurance Loss Control » Risk Control Programs
Full text of risk management policy and procedure manuals
Full text of risk management policy and procedure manuals
State Risk Management Audit [11140] Full text of a risk management program audit / checklist - 22 pages
Laboratory Safety » Activation-Closure
Procedures to follow when designing, activating, moving or closing laboratories
Procedures to follow when designing, activating, moving or closing laboratories
Hazardous Material Close Out Procedures [16832]
Policy For Termination of Laboratory use of Hazardous Materials - plus, checklist
Policy For Termination of Laboratory use of Hazardous Materials - plus, checklist
Laboratory Safety » Lab Checklists
Safety inspection checklists, audit forms and procedures designed for laboratory
Safety inspection checklists, audit forms and procedures designed for laboratory
Laboratory Safety » Lab Hazards
Chemical Hygiene Plans, standard operating procedures, lab safety programs, etc.
Chemical Hygiene Plans, standard operating procedures, lab safety programs, etc.
Controlled Substances [16867]
Conducting research using controlled substances - forms, policies, regulations, etc.
Conducting research using controlled substances - forms, policies, regulations, etc.
Physical Hazards » Hearing Conservation
Hearing conservation programs, acoustics, hearing protection devices, etc.
Hearing conservation programs, acoustics, hearing protection devices, etc.
Hearing Conservation Checklist [18896]
Sample Format for Audiometric Test Records & Hearing Conservation Program Checklist
[18896] Sample Format for Audiometric Test Records & Hearing Conservation Program Checklist
Sample Workplace Violence Prevention Program [9665]
Sample workplace violence program, checklist, incident report form
Sample workplace violence program, checklist, incident report form
Physical Hazards » Slips and Falls
Technical safety materials on falls from walking and working surfaces
Technical safety materials on falls from walking and working surfaces
Walking - Working Surfaces Checklist [18899]
Walking - Working Surfaces Checklist also includes ladders and scaffolds
[18899] Walking - Working Surfaces Checklist also includes ladders and scaffolds
Physical Hazards » Thermal Comfort
TLV's for heat and cold exposure, thermal stress, thermal comfort guidelines
TLV's for heat and cold exposure, thermal stress, thermal comfort guidelines
Canada: TLVs for Heat and Cold Exposure [18887]
Canadian health and safety regulations with respect to thermal conditions in the workplace
Canadian health and safety regulations with respect to thermal conditions in the workplace
PPE Programs » PPE Safety Programs
Sample PPE safety programs, checklists, tutorials, technical briefs
Sample PPE safety programs, checklists, tutorials, technical briefs
Personal Protective Equipment Safety Checklist [18912]
Sample program checklist form for evaluating the need for PPE
Sample program checklist form for evaluating the need for PPE
PPE Hazard Assessment Form [21599]
Selection of the proper personal protective equipment for a job is important
Selection of the proper personal protective equipment for a job is important
PPE Hazard Review Forms [23124]
Use the following charts and tables to complete a hazard assessment of your worksite
Use the following charts and tables to complete a hazard assessment of your worksite
Sample PPE Inspection Checklists [18825]
What to look for when inspecting clothing, gloves and fully encapsulating suits
What to look for when inspecting clothing, gloves and fully encapsulating suits
Laser Operations Checklist [18906]
Sample checklist and safety rules for laser operations - covers Class 1, 2, and 3a lasers
[18906] Sample checklist and safety rules for laser operations - covers Class 1, 2, and 3a lasers
Radiation Safety » Workplace Radiation
Radiation control programs, technical manuals, tutorials and more
Radiation control programs, technical manuals, tutorials and more
Ionizing and Non-ionizing Radiation Checklist [18902]
Sample checklist and safety rules for ionizing and non-ionizing radiation
[18902] Sample checklist and safety rules for ionizing and non-ionizing radiation
Radiation Program Forms & Instructions [14005]
In actual use in a laboratory radiation safety program created by a government agency
In actual use in a laboratory radiation safety program created by a government agency
Radiation Safety Guide [13998]
Full text of a radiation safety guide in use by a government laboratory
Full text of a radiation safety guide in use by a government laboratory
Radiation Safety Service [861] Radiation safety protocols, radionuclide training guide, isotope data sheets, forms
Sample Playground Equipment Inspection Checklist [19571]
Checklist for safety equipment and location hazards
Checklist for safety equipment and location hazards
Respiratory Safety » Confined Space Program
Technical resources related to confined space requirements
Technical resources related to confined space requirements
Confined-Space Pre-entry Checklist [27067]
Checklist must be filled out whenever workers enter a permit required space
[27067] Checklist must be filled out whenever workers enter a permit required space
Respiratory Safety » Indoor Air Quality
IAQ guides, checklists, fact sheets, sick building syndrome & more
IAQ guides, checklists, fact sheets, sick building syndrome & more
Indoor Air Quality Checklist [18898]
Common indoor contaminants TLVs and Indoor Air Quality Checklist
[18898] Common indoor contaminants TLVs and Indoor Air Quality Checklist
OSHA Respiratory Standard; Medical Evaluation Questionnaire [7917]
OSHA requires the employee to fill out a medical questionnaire - sample template provided
OSHA requires the employee to fill out a medical questionnaire - sample template provided
Respiratory Protection Checklist & Program [18895]
Sample respiratory protection program and checklist, respirator medical evaluation questionnaire
[18895] Sample respiratory protection program and checklist, respirator medical evaluation questionnaire
Respiratory Safety » Sampling
Technical guides on industrial hygiene air & noise sampling, monitoring, etc
Technical guides on industrial hygiene air & noise sampling, monitoring, etc
Customer Service Manual [5897]
US Army manual provides guidance on how to order IH sampling and lab services
US Army manual provides guidance on how to order IH sampling and lab services
Emergency Response Agreements Checklist [18909]
Checklist currently in use by the US National Weather Service
[18909] Checklist currently in use by the US National Weather Service
Essential Corporate Documents and Records Kit Checklist [26903]
To recover after an emergency or disaster, you will need to access your organization's essential records
To recover after an emergency or disaster, you will need to access your organization's essential records
Safety Forms » Ergonomics Checklists
Checklists designed to evaluate proper ergonomic workstation arrangements
Checklists designed to evaluate proper ergonomic workstation arrangements
Human Factors: Process Hazard Analysis Evaluation of External Forces [16842]
Includes human factors, facility siting issues, and external events (earthquake, floods, etc.)
Includes human factors, facility siting issues, and external events (earthquake, floods, etc.)
Laboratory Workstation Evaluation Checklist [26812]
Identify risk factors that can contribute to work-related musculoskeletal problems
Identify risk factors that can contribute to work-related musculoskeletal problems
Performance Oriented Ergonomic Checklist For Computer (VDT) Workstations [19238]
Designed to help you to evaluate what is needed for a good ergonomic workstation arrangement
Designed to help you to evaluate what is needed for a good ergonomic workstation arrangement
ID-Idaho Fire Inspection Form for Daycare Centers [23675]
Download a fire safety inspection form for daycare centers
Download a fire safety inspection form for daycare centers
Safety Forms » Inspection Forms
Safety self-inspections, self-evaluation checklists, yes/no questions
Safety self-inspections, self-evaluation checklists, yes/no questions
Canada: Workplace Inspections [17611]
Sample Inspection Check Sheet and guidance for conducting a safety inspection
Sample Inspection Check Sheet and guidance for conducting a safety inspection
Chemical Safety Checklist - Laboratories [27877]
Use this form to document periodic lab inspections as designated in your CHP
Use this form to document periodic lab inspections as designated in your CHP
Construction Jobsite Safety Inspection Checklist [25913]
To be used to inspect job sites for safety compliance
[25913] To be used to inspect job sites for safety compliance
Electrical Residential Safety Checklist [26886]
Checklist to make certain your residence is electrically safe
Checklist to make certain your residence is electrically safe
Electrical Workplace Safety Checklist [26887]
Checklist to make certain your workplace is electrically safe
Checklist to make certain your workplace is electrically safe
Heat Stress: General Workplace Review [18828]
Sample questions of what to ask when investigating heat stress in the workplace
Sample questions of what to ask when investigating heat stress in the workplace
Laboratory Employee Training Checklist [14056]
Employee training checklist form to document safety training (pdf)
[14056] Employee training checklist form to document safety training (pdf)
Laundry Health & Safety Inspection Checklists [29020]
Checklists of potential safety hazards in an industrial laundry
Checklists of potential safety hazards in an industrial laundry
Process Hazard Analysis Evaluation of External Forces [16843]
Includes human factors, facility siting issues, and external events (earthquake, floods, etc.)
Includes human factors, facility siting issues, and external events (earthquake, floods, etc.)
Safety Guidelines for the Home Work Space [9145]
Sample safety checklist for home-based telecommuters
Sample safety checklist for home-based telecommuters
Safety Inspection Checklists [27278]
Office Safety Checklist, Laboratory Safety Checklist, Shop Safety Checklist
Office Safety Checklist, Laboratory Safety Checklist, Shop Safety Checklist
Safety Forms » OSHA Forms
Download OSHA logs and forms for workplace injury recordkeeping requirements, co
Download OSHA logs and forms for workplace injury recordkeeping requirements, co
