EHS forms are supplemental to many guides, plans, and manuals. Please review the corresponding guide, plan, or manual for each form before completing or submitting a form to EHS. Please contact EHS if you are unable to find a form or need further instructions on how and when to complete any of the below forms.
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AED Incident Report Form
- AED Incident Report Form (PDF)
Bomb Threat Checklist
The Bomb Threat Guide provides guidance on how to respond to a bomb threat or a caller who claims a bomb is located on campus. The Bomb Threat Checklist should be used in the event a bomb threat is received by phone. Please refer to the Bomb Threat Guide for instructions on how to complete the Bomb Threat Checklist. All bomb threats received by George Mason University faculty, staff, or students must be reported to the University Police.
- Bomb Threat Checklist (PDF)
Shelter Preparation Form
Use the Shelter Preparation Form to identify an appropriate shelter area and office/department specific procedures and resources. Please refer to the Tornado and Severe Weather Guide for more information.
- Shelter Preparation Form (PDF)
Crowd Manager Contact Form
Crowd Managers must be present at all events where attendance is 1,000 persons or more to assist with fire emergencies and building evacuations. The Crowd Manager Guide provides instructions on how to identify, train, and assign crowd managers.
The Crowd Manager Contact Form is filled out by the Principal Crowd Manager and approved by the Event Coordinator. The form must be completed and submitted to EHS before an event may take place.
Hot Work Permit Application
Temporary Structure Permit Application
Unit Fire Safety Plan Form
Equipment Decontamination Certificate
This form should be used when equipment is being moved from the laboratory. Instruments or equipment must be certified as being free from potentially hazardous contamination prior to maintenance, repair, or removal by unprotected, untrained personnel.
Shipment of Hazardous Materials Form
Institutional Biosafety Committee (IBC) Registration
An IBC Registration Form must be completed for all research and instructional projects involving the use of biological materials and/or sources of ionizing radiation at George Mason University.
- Section B – Infectious Agents (.doc)
- Section C – Human or Nonhuman Primate Material (.doc)
- Section D – Recombinant or Synthetic Nucleic Acid Molecules (.doc)
- Section E – Biologically-Derived Toxins (.doc)
- Section F – Animals (.doc)
- Section G – Protocol Modification Request (.doc)
Please review the Radiation Safety Manual (coming soon) for more information on the below forms. Contact EHS with any questions or concerns about radiation safety.
Minors in the Laboratory
Contact EHS with any questions or concerns about minors who will be working in George Mason University laboratories.
Laboratory Training Signature Sheet
Laboratories are required to keep records of specific laboratory training provided to personnel. Please print and sign your name and indicate (with an “x” or check mark) if you have been trained on the contents of your laboratory’s Supplemental Safety Plan(s) and are familiar with George Mason University’s Safety Manual(s). This Laboratory Training Signature Page should be kept in the Safety Records and Resources binder. Learn more about EHS training sessions here.
Teacher Recommendation Form
Complete this form and return to EHS-Laboratory Safety via email at firstname.lastname@example.org or by fax at 703-993-8389. A copy of this form should also be submitted to the appropriate Principal Investigator/Laboratory Supervisor.
Indoor Air Quality (IAQ)
- IAQ Investigation Request Form (PDF)
- IAQ Symptoms Log (PDF)
- Supervisor Request for Air Monitoring Evaluation (PDF)
- Medical Clearance Form (PDF)
Accidents and Incidents
All accidents, injuries, or conditions that may cause harm should be reported to the university so that appropriate remediation or corrective measures can be taken to protect the university community from similar or future incidents. The following situations should be reported to the university:
- Employee Accident: An Incident Report Form should be completed whenever an accident (that does not result in injury), theft of university property, fire on university property, or unsafe condition occurs.
- Employee Injury: An Employer’s First Report of Accident Form must be completed when an employee is injured while at work.
- Student or Visitor Accident or Injury: An Incident Report Form should be completed whenever an accident, injury, or unsafe incident occurs involving a university student or visitor.
- University Property Damage: Damage to university property resulting from accident or emergencies must be reported to the Office of Risk Management via the Report of Loss to State Owned Property form.
- University/State Vehicle Accident: If you are involved in an automobile accident involving a university-owned vehicle you must complete an Automobile Loss Notice Form and submit it to the Office of Risk Management. If you are still at the scene, review the instructions on the envelope in the glove box of the state vehicle.
The forms listed above are used to investigate unsafe conditions, identify corrective actions to prevent accidents and incidents, and modify programs accordingly to improve safety on university property.
For more information regarding workplace injuries, exposures, or illnesses, please review the University Accident and Incident Plan. For questions regarding workers’ compensation please contact Human Resources and Payroll Workers’ Compensation at 703-993-7756. For information about insurance, university property damage/theft, and automobile incidents contact the Office of Risk Management at 703-993-2599.
Confined Space Entry Permit
Alternate Confined Space Entry Procedure Certification
The completed Alternate Entry Procedure Certification form must be posted at the entry point in addition to the Confined Space Entry Permit (above) and be available for review for the duration of the confined space project.
Job Safety Analysis (JSA)
Job Safety Analysis (JSA) is a procedure that focuses on individual job tasks to identify hazards and prevent injury or exposure by employing appropriate engineering, administrative, physical controls, as well as personal protective equipment (PPE). The JSA process focuses on the relationship between the worker, the task, the tools, and the work environment. JSA document steps that must be taken to eliminate or reduce workplace hazards to an acceptable risk level. Please refer to the JSA Guide for help completing this form.
Supervisors are responsible for maintaining the following records in order to meet the requirements of the Lockout / Tagout Plan:
Machine and Machine Shop Safety
Before operating a forklift, classroom and hands on training is required. For more information about how to operate a forklift safely, please reference the Forklift Safety Guide. Register for Powered Industrial Truck training here.
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