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Forms

Additional Form Areas

Accelerator Systems Docs | BIS Forms (including Property Forms) | Purchasing Forms for Buyers | NLC Safety Documents | New Employee Checklist | SSRL Forms

General Forms

Project ESH Review Process (through BIO)

  • PDFProject Review Procedure
  • PDF | Word Threshold Review Form
  • PDF | Word Project Review Traveler Form (Building Inspection Office)
  • onlineBuilding Inspection Office (BIO) Project Review Database

Management Walkthroughs

  • online Action Tracking System (ATS)
  • PDF Walkthrough Procedure

Work Planning and Control

WPC Procedures

  • PDF | Word Activity Training and Authorization Form
  • PDF | Word Job Safety Analysis Form
  • PDF | Word SOP Authorization and Release Form
  • PDF | Word Work Integration Plan Form
  • PDF | Word Construction Tailgate/Pre-job Release Form
  • PDF | Word Non-construction Tailgate/Pre-job Release Form

Stop Work Procedure

Area Hazard Analysis Procedure

  • online SLAC-Internal page Area Hazard Analysis eTool

See the SLAC-Internal page Work Planning and Control Website for more forms and references

Information Management

  • email IT Help-ESH Computing Notification System
  • online ESH Website Work Request Form
  • onlineESH Manual Revision Proposal Form

Environmental

  • 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 Hazardous Waste Determination Form
  • PDF Hazardous Waste Pick-Up and Empty Container Request Form
  • PDF Hazardous Waste Pick-Up and Empty Container Request Instructions
  • PDF | WordHazardous Waste Collection Area Weekly Inspection Checklist
  • Word NEPA: Environmental Compliance Checklist
  • PDF | Word Spills Report Form
    Radioactive Material Management Area (RMMA) Hazardous Material Pickup Request: Call  Ext. 2479

Stormwater

  • PDF | Word Stormwater: General Inspection Checklist
  • PDF | Word Stormwater: Storm Drain Inspection Form
  • PDF | Word Stormwater: Contained Water Release Form

Occupational Health Center (Medical)

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
  • PDF | Word Job Safety Analysis for Employee Office Moves
  • 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)
    - Alternate Hardcopy [pdf]
  • online Dosimeter/ID Request Form B (escort required in restricted access areas, visitors, personnel w/o training)
    - Alternate Hardcopy [pdf]
  • PDF Dosimeter/ID Request Form C (for groups)
  • PDF Dosimeter-Lost/Damaged Form
  • PDF Hazardous Waste Determination Form
  • PDFLead Transfer Form
  • PDFMixed Waste Generation Checklist
  • PDFMixed Waste Generation Request Form
  • online Mixed Waste Potential Items List
  • PDF | WordRadioactive Material Declaration Form
  • WordRadiological Work Permit Application (RWP)  SLAC-Internal page
  • Word Salvage Form
    Property Control info - Use and Disposal - call ESH x4299 for a radiological survey

Training

For Trainees

  • online SLAC Training Registration & Payment System
  • PDF SLAC Training Transfer/Sign-Off

For Trainers

  • Word Blank Class Roster
  • PDF Course Evaluation Form  SLAC-Internal page
  • Word Course Needs Analysis Form

Traffic and Vehicular Safety

  • PDFSLAC Motorized Driving Privilege Form
  • PDFSLAC Vehicle Registration Form
  • webpageother Chapter tools

Safety

  • online Emergency Evacuation Sign
  • ppt Emergency Slide (safety information)
  • Word Facility Emergency Plan Template
  • PDF Facility Inspection Checklist

Bloodborne Pathogens

  • PDF Sharps Disposal Procedure
  • PDF Post-exposure Procedure
  • PDF Hepatitis B Vaccine Offer and Declination Form
  • PDFBlood-borne Pathogens PPE

Building Inspection Office

  • PDF | WordProject Review Traveler Form 
    (part of ESH Manual Ch 1, also in Project ESH Review Process)
  • PDF | WordBIO: Adhesive Anchor Checklist Also listed in Penetrations  SLAC-Internal page
  • PDF | WordBIO: Mechanical Anchor Checklist Also listed in Penetrations  SLAC-Internal page
  • PDFConstruction Authorization and Inspection Record SLAC-Internal page
    (AKA "Inspection Card")

Compressed Gas Cylinders

  • PDF | Word Point of Delivery Inspection Form

Confined Space

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

Control of Hazardous Energy

  • Excel Group Lockout Energy Isolation Plan Template
  • Excel Complex Lockout Permit
  • Word Equipment-specific Lockout Procedure (ELP) Template
  • PDF Authorized Worker Certification Form
  • Word Tag Templates
  • PDF Alternative Authorization for Removing Locks and Tags 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 | Word Competent & Qualified Person Designation Form
  • PDF | Word Elevated Surface Work Plan

Fire and Life Safety

  • PDF Underground Fire Valve Impairment Authorization Form
  • PDF Sprinkler / Standpipe Impairment Authorization Form
  • online Hot Work Permit-Fire System
  • online Fire Extinguisher Service Request Form

Hazardous Materials

Hoisting & Rigging Safety

  • PDF | Word Crane and Hoist Monthly Inspection Form
  • PDF | Word Lift Planning and Control for Ordinary Lifts (sample)
  • PDF | Word Review of Conformance Form
  • PDF | Word Visual Structural Weld Inspection Criteria and Form
  • PDF | Word Pre-use Inspection Checklist for Hand-operated Hoists
  • PDF | Word Pre-use Inspection Checklist for Floor-operated Cranes
  • PDF Mobile Crane Pre-use Inspection Form
  • PDF | Word Pre-use Inspection Checklist for Electrical or Air Powered Hoists
  • PDF Pre-use Inspection Criteria for Below-the Hook Lifting Devices, Slings, and Rigging Hardware and Accessories
  • H&R Guides and Procedures

Incident Investigation

  • PDF Chain of Custody Form
  • PDF Employee First Report of Injury (SU-17A)
  • Word Incident Investigation Form (SU-17B)

Ladders

Laser Safety

  • PDF Qualified Laser Operator Approval Form
  • PDF System Laser Safety Officer Approval Form
  • PDF Approval to Operate Form
  • 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 Permit Form
  • PDF | WordBIO: Adhesive Anchor Checklist*  SLAC-Internal page
  • PDF | WordBIO: Mechanical Anchor Checklist*  SLAC-Internal page
  • * Also listed in BIO

Personal Protective Equipment (PPE)

  • Reimbursement for required prescription safety glasses
    Complete the Prescription Safety Glasses Approval Form and attach to the Special Payment Request Form, both of which can be found on the Finance Reimbursement webpage
  • Reimbursement for required protective footwear
    Complete the Protective Footwear Approval Form and attach to the Special Payment Request Form, both of which can be found on the Finance Reimbursement webpage.
  • See other categories for PPE forms for specific hazards.

Powered Industrial Vehicles (Forklifts, etc)

  • 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

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

Subcontractor Safety

  • onlineBIO Project Review Database
  • PDFWorker Safety and Health Program Acknowledgement Form
  • PDFSubcontractor Safety Qualification Form
  • PDFSubcontractor Safety Qualification Evaluation Form
  • PDFSite-specific Safety Plan Content and Approval Form
  • onlineSubcontractor Safety SharePoint Site  SLAC-Internal page
  • onlineWork Classification Form (Green or Assessment
  •  SLAC-Internal page

 

   

 


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