ESH Forms and Templates

PDF | Word Air Quality: Emissions Source Inspection Form
PDF | Word Air Quality: Monthly Hazardous Material Use, Fuel Consumption, and Equipment Operation Forms
Excel Chain of Custody Form (general)
PDF Container and Collection Area Weekly Inspection Checklist (Hazardous Waste)
Hazardous Waste Determination Form - See Radiation Forms
PDF Hazardous Waste Pick-Up and Empty Container Request Form
PDF Hazardous Waste Pick-Up and Empty Container Request Instructions
Word NEPA: Environmental Compliance Checklist
PDF | Word Spills Report Form
Radioactive Material Management Area (RMMA) Hazardous Material Pickup Request: Call Ext. 2479

Stormwater

PDF Stormwater: General Inspection Checklist
PDF Stormwater: Contained Water Release Form
PDF | Word Stormwater: Erosion and Sedimentation Control Plan Form

Occupational Health Center (Medical)

Word SLAC SU-17A - Employee First Report of Injury (also available from the SLAC Occupational Health Center)
online (related form) First Report of Incident (also listed under Incident Investigation)

Ergonomics

PDF Industrial Ergonomics Screening Checklist

Safe Office Moves

PDFSteps for Safe Office Moves
PDFNew Office Safety and Ergonomics Checklist
PDFSafe Office Moves Checklist for Supervisors
see the Safe Office Moves webpage for more information and tools, including a slideshow

Radiation

PDF Authorization to Release Occupational Exposure Information
PDF Declaration of Pregnancy Form
PDF - Withdrawal of Declaration of Pregnancy Form
online 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]
PDF Dosimeter/ID Request Form C (for tours in SAA)
PDF Dosimeter-Lost/Damaged Form
PDF Hazardous Waste Determination Form
PDF Mixed Waste Generation Checklist
PDF Mixed Waste Generation Request Form
online Mixed Waste Potential Items List
PDF Non-DOE Assignment Notification Form
online Radiological Issue Report (RIR) Form
PDF Radioactive Material Declaration Form
onlineRadioactive Survey Request
onlineRadiation Generating Device (RGD) Registration Form for I-IV
onlineRadiological Work Permit (RWP)
- internal online form - if off-site, requires VPN access
online RP Walk-Through Inspection/Assessment Reports
to form Salvage Form (non-ESH Form, for use with ESH Radiological Surveys)
More information at SCM Property Control: Surplus
PDF Sealed Radioactive Source Acquisition Authorization Form

Site Access Control

online Arrillaga Center Family Badge Request
online Site Access Portal
PDF | Word Subcontracting After-hours Authorization Form

Traffic and Vehicular Safety

in officeSLAC Vehicle Registration Form
PDFTemporary Traffic Control Plan Approval Form
webpageother Chapter tools

Work Planning and Control

WPC Procedures

PDF | Word Activity Training and Authorization Form
online Hazard Evaluation and Planning eTool
PDF | Word Job Safety Analysis Form
PDF | Word SOP Authorization and Release Form
online Term Release Tool
PDF Work Integration Plan Form
PDF | Word Non-construction Tailgate/Pre-job Release Form

Construction Procedure

PDF | Word Construction Job Safety Analysis Form
PDF SLAC Receipt of Subcontractor Form
PDF Construction Pre-job Briefing Checklist
PDF | Word Construction Tailgate/Pre-job Release Form

Stop Work Procedure

PDF | Word Stop Work Form

Area Hazard Analysis Procedure

online Area Hazard Analysis eTool

See the Work Planning and Control Website for more forms and references

Safety Forms

online Emergency Evacuation Sign
ppt Emergency Slide (safety information)

Beryllium

PDF Beryllium Inventory Form

Bloodborne Pathogens

PDF Hepatitis B Vaccine Offer and Declination Form

Building Inspection Office

PDF | WordBIO: Adhesive Anchor Checklist Also listed in Penetrations
PDF | WordBIO: Mechanical Anchor Checklist Also listed in Penetrations
PDFConstruction Authorization and Inspection Record
(AKA "Inspection Card")
online Building Inspection Office (BIO) Plan Review System

Chemical Safety and Lifecycle Management

onlineChemical Management Services (CMS) System (see webpage for use)
pdf | Word CLM: Toxic and Hazardous Chemical Justification Form
pdf | Word CLM: Storage Area Inspection Form

Confined Space

PDF Confined Space: Entry Permit
PDF Confined Space: Alternate Entry Form
PDF Confined Space: Non-permit Required Confined Space Entry Form
PDF Confined Space: Temporary Declassification Form

Control of Hazardous Energy

For current forms and templates, please see: CoHE Safety Program > Document Library > Forms And Templates

Cryogenic and ODH

PDF | Word ODH Safety Review Form

Electrical Safety

PDF | Word Electrical Work Plan
PDF | Word Energized Electrical Work Request & Approval Permit

Excavation Safety

PDF | Word Excavation Permit Form
PDFUtility Location Results Form
PDFDaily Inspection Checklist
PDFMobile / Portable Drilling Rig Initial Inspection Form

Fall Protection

PDF Elevated Surface Work Plan

Fire and Life Safety

online Hot Work Permit System
Subcontractor Hot Work Request
PDF (Contractors can download, then send to the FCM, who will fill out online system form using this information)
email Fire Extinguisher Service Request

Hazardous Materials and Waste Transportation

onlineChemical Management Services (CMS) System (see webpage for use)
online SLAC eShipper

Hoisting & Rigging Safety

PDF Review of Conformance Form
PDF Crane Pre-use/Frequent Inspection Form
PDF Mobile Crane Pre-use Inspection Form
PDF Ordinary Lift Planning and Control Form
PDF | Word Critical Lift Planning and Control Form
H&R Guides and Procedures

Incident Investigation

Word SLAC SU-17A - Employee First Report of Injury
online First Report of Incident
Word SLAC SU-17B - Incident Investigation
PDF (related) Incident Reporting and Investigation Process

Industrial Trucks

PDF Inspection Checklist
PDF Taylor-Dunn C-425 Electric Tow Tractor Inspection Checklist
PDF EnerSys Enforcer Battery Charging Trailer Inspection Checklist
PDF Powered Pallet Jack Inspection Checklist

Ladders

PDF Fixed Ladder Inspection Checklist
PDF Portable Ladder Pre-Use Inspection Checklist
See also ladder safety procedures and tools, including:
PDF - Using Portable Ladders Safely

Laser Safety

online Laser Worker Approval
PDF System Laser Safety Officer Approval Form
PDF Acting System Laser Safety Officer Approval Form
PDF Approval to Operate Form
online Laser Safety Tool
online Laser Safety SharePoint Site

Lead Safety

PDF Lead Transfer Form
PDF Standard Lead Shielding Purchase Justification Form

Mobile Elevating Work Platforms (Manlifts, etc)

PDF Inspection Checklist

Penetrations

PDF | Word Penetration Permit Form
PDF | WordBIO: Adhesive Anchor Checklist*
PDF | WordBIO: Mechanical Anchor Checklist*
* Also listed in BIO

Personal Protective Equipment (PPE)

PDFPPE Purchase Approval Form
PDFN95 Approval Procedure - Voluntary Use for COVID-19 Protection
See other categories for PPE forms for specific hazards.

Pressure Systems

PDF New Pressure System Registration Form
PDF Legacy Pressure System Registration Form
PDF Inspection Report Form
PDF Maintenance and Repair Report Form
PDF Pressure Test Plan Form
PDF Pressure Test Record Form
online Pressure Systems Database

Respiratory Protection

PDF Respirator User Form
PDFN95 Approval Procedure - Voluntary Use for COVID-19 Protection

Subcontractor Safety

onlineBIO Project Review Database
PDFInjury and Illness Prevention Program Acknowledgement Form
PDFSubcontractor Safety Qualification Form
PDFSubcontractor Safety Qualification Evaluation Form
PDFSite-specific Safety Plan Content and Approval Form
PDFSubcontractor Safety Staff Needs Assessment Form
onlineSubcontractor Safety SharePoint Site
onlineWork Classification Form (Green or Assessment)

Questions?
Last update: