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Environmental Safety Forms

Key information and forms for UVM's Environmental Safety Plan for laboratories are available for download here:

Guide to Managing Chemical Waste in UVM Laboratories

Informational brochure (in PDF format) that describes UVM's chemical waste management system and how you can Prevent Pollution by reducing the amount of hazardous chemical waste your work produces.

Chemical Use Planning Form

The Chemical Use Planning Form is designed to help laboratory supervisors and safety officers outline the precautions necessary for the use of specific chemicals or groups of chemicals with similar hazards. These forms are also used to register the use of specific chemicals with Environmental Safety for Institutional Research Committee purposes. The form is available in three formats:

Microsoft Word
document

PDF
(to be printed
and completed on paper)

Microsoft Word template
(to be completed
and managed electronically)

In concert with Chemical Use Planning Form itself, the UVM Hazardous Chemicals of Concern list (here in PDF format) groups the most common laboratory chemicals into hazard and compatibility groups and provides information about special attention specific chemicals need for safe management.

Laboratory Decommissioning Form

PDF Form to notify us of a laboratory that is being decommissioned and needs removal of excess chemicals. Please give us at least three weeks notification before the work must be completed.

Laboratory Self-Inspection Form

The UVM Laboratory Self Inspection cards in pdf format outline the monthly inspections that UVM laboratories must conduct. These are also used by Environmental Safety auditors during laboratory visits. They are printed in color; e-mail us for pre-printed copy if the black and white version here does not print well.

Emergency Eye Wash and Shower Flush Log

A 2007 calendar in pdf format for recording dates when eyewashes and safety showers were flushed; self inspections were conducted and any dates when the laboratory was closed for use. These are also printed in color; e-mail us for pre-printed copy if the black and white version here does not print well.

Laboratory Safety Training

A description of the Environmental Safety training program can be found on our web page. We also have an outline of laboratory specific training in PDF format that each supervisor should provide laboratory workers.

On-line access to training records for training provided by Risk Management & Safety staff. Requires UVM NetId to use.

Bloodborne Pathogen Program Forms:

Risk Designation Form

This form is for supervisors to use to designate a specific laboratory worker as "at risk" for exposure to human blood or body fluids. This designation means that UVM is responsibile for providing access to Hepatitis B vaccine series for this work. Take this form to the medical provider who provides the vaccination series and maintain a copy in the laboratory safety notebook.

Consent/Refusal Form

This form is completed by the employee to indicate whether they consent to having the vaccine. Copies should be kept with the risk designation form.

 

Last updated: January 3, 2007