FORMS
| Name | Description |
|---|---|
Animal Handler Referral Form
|
To be used animal handler job duty |
|
Ductless Fume Hood Application
|
To be used to apply for a ductless fume hood |
|
Laser Use Authorization
|
To be used to register a laser |
|
Pregnancy Declaration
|
To be used to declare pregnancy |
|
Radiation Use Authorization
|
To be used to request approval to work with radiation |
|
Moving/Vacating a Laboratory Space Checklist
|
To be used when moving or vacating a laboratory space. |
| Name | Description |
|---|---|
|
INF 254 - Request for Driver's License Information
|
To be used to authorize driving record release |
|
STD 261 Authorization to Use Privately Owned Vehicles on State Business
|
To be used to request authorization to use privately owned vehicles on state business |
|
STD 269 - Accident Identification
|
To be used to document vehicle accident |
|
STD 270 - Vehicle Accident Report
|
To be used to document vehicle accident |
|
STD 274 - State Driver Accident Review
|
To be used to document state driver accident |
| Name | Description |
|---|---|
|
Application for Temporary Permit: Food and Beverage Distribution
|
To be used to apply for permit for temporary food facility |
| Name | Description |
|---|---|
|
Brea Urgent Care Medical Authorization Form
|
Used at Fullerton main campus to authorize treatment at Brea Urgent Care |
|
Employee/Volunteer Injury/Illness Report
|
To be completed following employee/volunteer injury/illness |
|
First Aid Supplies
|
To be used to maintain first aid supplies |
|
Hepatitis B Virus Vaccination Decision Form
|
To be used to document an employee’s declination or acceptance of Hepatitis B Virus vaccination |
|
Medical & Exposure Records Request
|
To be used to request medical and exposure records |
|
Medical Record Information Authorization Release
|
To be used to authorize release of medical records |
|
Student or Visitor Injury/Illness Report
|
To be completed following student/visitor injury/illness |
|
Supplemental Information to Exposure Reporting Form
|
To be used to document a sharps injury. |
| Name | Description |
|---|---|
|
Asbestos Abatement Project Notification
|
To be used to document project involving asbestos abatement |
| Campus Safety Report | To be used to report a hazard, liability, or complaint |
|
Confined Space Entry Permit
|
To be used to document confined space work |
| Ergonomics Evaluation Form | To be completed to request an ergonomics evaluation |
|
Hot Work Permit
|
To be used to document hot work |
|
JHA Template
|
To be used to document a job hazard analysis. |
|
Roof Access Permit
|
To be used to request approval to access roof |
|
Site Safety Orientation Checklist
|
Orientation checklist for labs or technical areas. |
|
Training Evaluation Form
|
To be used to evaluate safety training |
