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DEHS Forms
Program Forms
Biosafety:
- Form for DOD Grant Applicants
- Form for DOE Grant Application
- Biosafety Level 1 Sign (PDF)
- Biosafety Level 2 Sign (PDF)
- Bloodborne Pathogen Record of Training Form (PDF)
- Lab Biosafety Self Audit Form
- Biological Decontamination & Spill Clean-up Plan Template
- Biological Waste Disposal Plan
Chemical Safety Day Program:
- Form A: Pure Chemicals (PDF)
- Form B: Chemical Mixtures (PDF)
- Form C: Commercial Products (PDF)
- Form D: Unknown Laboratory Samples (PDF)
Controlled Substances:
DOD: Department of Defense
DOE: Department of Energy
Emergency Management:
Food, Water, Housing:
- Food Permit (PDF)
Hazardous Waste
Hazardous Waste Packing Form is available by calling 612-626-1604, or email hazwaste@umn.edu.
- Chemical and Labware Request Form (HTML)
- Emergency Information and Phone Numbers (PDF)
- Hazardous Material Transport Form (PDF)
- Hazardous Waste Generator Record of Training (PDF)
- Hazardous Waste Video Record of Training Form (PDF) *
- Hazardous Waste Weekly Inspection Form 1 (PDF)
- Hazardous Waste Weekly Inspection Form 2 (PDF)
- Request for Permission to Dispose of Chemicals by Sewer or in Trash (PDF)
- Unknown Preliminary Analysis Checklist (PDF)
Laboratory Safety *
- Child labor exemption permit - minors 16 to 17 years of age (HTML)
- Child labor exemption permit - minors under 16 years of age (HTML)
- Information regarding exemptions to these forms (HTML)
- Parental/Guardian Hazard-Acknowledgment Form (HTML)
- Cardiovascular Division Laboratory Safety Information Sheet (HTML)
- Laboratory Audit Checklist (HTML)
- Employee Incident Report (HTML)
- Form BA725a, Laboratory Safety Standard Training Record (HTML)
Radiation Protection *
- Analytical X-ray Guide (Microsoft Word)
- Animal and Sharps Container Information Sheet (Microsoft Word), (PDF)
- Compliance and Enforcement Policy (Microsoft Word), (PDF)
- Decay Charts (HTML)
- Declaration of Pregnancy (Microsoft Word), (PDF)
- Declared Pregnant Radiation Workers Policy (Microsoft Word), (PDF)
- Dosimetry Policy (Section X, Radiation Protection Manual) (Microsoft Word), (PDF)
- Human Use Application (Microsoft Word)
- Initial training form (Microsoft Word)
- Maintenance record form (Microsoft Word)
- Order Form for Radioactive Material (Microsoft Word), (PDF)
- Order Form Guide (Microsoft Word), (PDF)
- "Out of Service" sign (Microsoft Word)
- Permit Amendment Form (Microsoft Word), (PDF)
- Prenatal exposure guide (Microsoft Word)
- Quarterly Report Form (Microsoft Word), (PDF)
- Quarterly Report Instructions (Microsoft Word), (PDF)
- Quarterly system test form (Microsoft Word)
- Laboratory Survey Form (Microsoft Word), (PDF)
- Radioactive Materials Permit Application (Microsoft Word), (PDF)
- Radioactive Materials Permit Guide (Microsoft Word), (PDF)
- Record of Training (Microsoft Word), (PDF)
- Refresher training form (Microsoft Word)
- State of Minnesota Rules (HTML)
- Scintillation Waste and Stock Vial Container Information Sheet (Microsoft Word), (PDF)
- Waste Form for Radioactive Material (Microsoft Word), (PDF)
- Waste Inventory Form (Microsoft Word), (PDF)
- Waste Inventory Instructions (Microsoft Word), (PDF)
- X-ray use log (Microsoft Word)
- UMD faculty and staff
Respiratory Protection Program:
The Department of Occupational Health and Safety (OHS) provides respirator medical evaluations online. Follow this link to the OHS Respiratory Protection Program (RPP) enrollment page.
Enrollment in the OHS RPP is voluntary if you are not part of the academic health center, however there are several advantages in using their service.
- The medical evaluation is available online through Employer Health Services, LLC, and in addition OHS will maintain the records. If you need a medical evaluation form, follow this link for the HealthPartners form.
- OHS has partnered with the HealthPartners department of occupational medicine for clinical services.
- Fit testing instructions are available online, and fit tests can be scheduled with OHS after completion of the medical evaluation
- Written program and training materials are available on line as well.
If you choose to develop your own RPP or cannot use this service contact DEHS or OHS for further instructions.
Shipping
- Shipping Service Form (PDF)
* The above training, information, and procedures are based on materials prepared for use on University of Minnesota campuses. Neither its authors nor the University of Minnesota will accept responsibility for its contents if used in non-University of Minnesota settings.
