Divisions
Forms

Biological Safety

  1. CDC: Application Form for Import of Etiologic Agents
  2. Clinical Laboratory Safety Audit Checklist
  3. Laboratory Equipment Hazard Assessment Form
  4. EOC Survey Tool for the Off-Site HBCs 2016 – With Answers
  5. EOC Survey Tool for Hospital and On-Site HBCs 2016 – With Answers
  6. EOC Survey Tool for Ambulatory Care (DPCs, PDCs, and CPDCs) 2016 - With Answers
  7. Health Review for Animal Handlers Form
  8. Recombinant DNA Registration Form
  9. EOHW TB Questionnaire
  10. Respiratory Questionnaire/Medical Clearance Form: TB, SARS & Other Particulates
  11. Respiratory Questionnaire/Medical Clearance Form: TB, SARS & Other Particulates for Durham Regional Hospital

Environmental Programs

  1. Chemical Waste Logsheet
  2. Radioactive Waste Logsheet

Fire & Life Safety

  1. Hot Work Permit Form
  2. Fire Watch Building Tour Record

Occupational Hygiene & Safety

  1. Lift Truck Safety Inspection Form
  2. LOTO Annual Inspection Form
  3. Engineering & Operations LOTO Annual Inspection Form
  4. LOTO Procedure Template
  5. Confined Space Pre-Entry Hazard Assessment Form
  6. Site-Specific Respirator Medical Clearance Form
  7. SDS Order Form
  8. Weekly Eyewash Maintenance Log Sheet
  9. Chemical Standard Operating Procedure (SOP) Templates for Labs
  10. PPE Hazard Assessment Form
  11. Fieldwork Safety Plan Template

Radiation Safety

  1. Laser Registration Form-Paper Version
  2. Radiation Exposure History Release Form
  3. Lost Radiation Badge Certificate
  4. Radioactive Material Order Form -PDF
  5. Shipment Request Form-MS Word
  6. State of North Carolina X-ray Machine Registration Forms
  7. Lab Contamination Survey Form

 

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