Accident & Incident Reporting
Submit an Incident Report if you have or see an accident or incident on any EWU campus or while at an EWU related event or trip.
Safety Concern Reporting
Fill out a Safety Concern Report if you identify something on campus that you think could cause a problem if left uncorrected.
EH&S Service Request
Fill this out to request assistance from EH&S. This form can be used to request ergonomic evaluations.
Waste Pick Up Request
Fill out this form and attach the required Word document to request a pick up of hazardous waste.
Training Documentation Form – this form can be used to document any trainings provided to employees or students. Training records should be kept for at least 3 years. The records should also include any handouts given during the training. Training records can be sent to EH&S for retention.
Forms, Organized by Topic
Building Safety
Building Captain/Floor Manager Application Form
Fill out this form if you are interested in becoming a Building Captain or Floor Manager to help increase building safety and safety awareness.
The title link is to the online form. If you want to download a paper copy click here.
Dorm Safety Fire Extinguisher Checklist
RAs and CAs use this checklist to record your weekly fire extinguisher inspections. Turn them in to your Residential Life Coordinator at the end of the month.
Environmental Programs
Hazardous Waste
Download this form to request pickup of hazardous waste. When the form is filled out send it to EH&S at envhea@ewu.edu.
Waste Evaluation Request
Fill out this form to request waste disposal (in the sink, general garbage, or any other applicable method) for any waste you do not believe is classified as hazardous according to WA or federal regulations. When the form is filled out send it to EH&S at envhea@ewu.edu. Waste will be designated according to WA standards and you will be informed of the results.
Generator Inspection Records
Waste storage areas must be inspected every 7 days. Print this form and use it to track inspections of your waste storage area. When the form is filled out, scan it and send a copy to EH&S at envhea@ewu.edu or fax it to 509.359.4690.
Keep copies of past inspection logs for your records. These records should be kept for three years.
EWU Biosafety Manual
Please click this link to access the current EWU Biosafety Manual.
Hazardous Waste
Download this form to request pickup of hazardous waste. When the form is filled out send it to EH&S at envhea@ewu.edu.
Laboratories and Shops
Hazard Registration Form
This form should be filled out for all laboratories and shops on campus. It is designed to identify hazards that can be found in a lab/shop.
Reminders will be sent out annually to review the information and update it as necessary.
Hazard Door Sign
Use this PDF to fill out the hazard door sign. This is the door sign from the Annual Laboratory Hazard Registration Form above.
Biohazard Work In Progress Door Sign
Post this sign outside the lab whenever work is being done with potentially biohazardous materials.
EWU Biosafety Manual
Please click this link to access the current EWU Biosafety Manual.
Regulated Chemical Use Form
Everyone working with chemicals should submit this form annually to EH&S. This will ensure that anyone who needs respiratory protection for their chemical work is identified.
The title links to the web based form. If you would like to download a paper copy, click here.
Analytical X-ray Monthly Survey Record
Use this PDF form to record monthly surveys of analytical x-ray equipment on campus.
Analytical X-ray Daily Use Log
Use this PDF form to record use of analytical x-ray equipment on campus.
Guidance Document for Laboratory and Academic Shop Safety Work Practices for Equipment:
Use this link to review Safe Work Practices prior to using Equipment.
Hazard Registration Form
This form should be filled out for all laboratories and shops on campus. It is designed to identify hazards that can be found in a lab/shop.
Reminders will be sent out annually to review the information and update it as necessary.
Ladder Inspection Form
Use this ladder inspection form to ensure the ladder being used is in good condition before each use.
Confined Space Entry Permit
This form must be filled out before any entry into a Permit-Required Confined Spaces. This form is to be filled out by the Entry Supervisor and must be filed at Rozell upon completion of the confined space work.
Hot Work Permit
This form must be completed before any hot work takes place in a confined space. This form is to be completed along with the Confined Space Entry Permit above. It is to be filled out by the Entry Supervisor and filed with the Confined Space Entry Permit.
Abandoned Lock/Tag Removal Form
This form must be filled out anytime a supervisor or Lockout Coordinator removes a lock or tag that was left behind. Must be signed by the employee who left the lock/tag and submitted to the Facilities Operation Manager.
Equipment Inventory Form
Use this to record all equipment and systems that require lockout/tagout procedures.
Group Lockout/Tagout Procedure Worksheet
Fill out and use this worksheet for all group lockout/tagout procedures.
Individual Lockout/Tagout Procedure Worksheet
Fill out and use this worksheet for any individual lockout/tagout procedure that involves more than one energy source or energy isolation point.
Lockout/Tagout Equipment Specific Procedure
Every item on the Equipment Inventory Form requires a procedure. All procedures must be reviewed annually for compliance.
Tagout-Only Justification Form
Submit this form to the Facilities Operation Manager to get approval for Tagout-Only procedures.
Aerial Lift forms
Aerial Lift Pre-Inspection Form
Use this form to document the safety inspection of an aerial lift before you operate it. This form should be kept in Rozell with the lift clipboard when the lift is returned.
Lift Operators Personal Equipment Use Log
Use this form to log the amount of time you spend using powered lifts. A copy should be submitted to EH&S every three years during your lift training.
Fall Protection Forms
Anchorage Inspection Form
This form must be completed by employees prior to using an anchorage connector, every day the anchorage connector is used. It must also be filled out by the installer when a new anchorage connector is put in.
Fall Protection Work Plan
A Fall Protection Work Plan must be in place for any work with a fall hazard above 10 feet. The plan must be completed prior to the start of work and must be readily available at the work site for inspection.
Harness Inspection Form
This form must be filled out by the employee prior to donning a harness to document that they have fully inspected the harness for defects. If the harness will be used multiple times in one day, fill out the inspection form once at the start of the day.
Horizontal Lifeline Inspection Form
This form must be filled out by the installer of the horizontal lifeline after installation and by employees prior to each day’s use of the horizontal lifeline.
Lanyard Inspection Form
This form must be filled out by the employee prior to using a lanyard to document that they have fully inspected the lanyard for defects. If the lanyard will be used multiple times in one day, fill out the inspection form once at the start of the day.
Self-Retracting Lifeline Inspection Form
This form must be filled out by the employee prior to using a Self-Retracting Lifeline (SRL) to document that they have fully inspected the SRL for defects. If the SRL will be used multiple times in one day, fill out the inspection form once at the start of the day.
Vertical Lifeline Inspection Form
This form must be filled out by the installer of the vertical lifeline after installation and by employees prior to each day’s use of the vertical lifeline.
Occupational Health & Safety
Part-Time, Temporary and Student Health & Safety Orientation Form
Supervisors must fill out this form for each part-time, temporary and student employee. This records that the employees have received appropriate health and safety training before they begin work.
Information for Persons Voluntarily Using Respirators
Fill out this page if you are voluntarily using a respirator at Eastern. It is used to ensure you understand what voluntary use of a respirator is and the benefits and hazards associated with this decision. Keep a copy for your records and send a copy to EH&S.
Initial Medical Questionnaire for Employees with Animal Contact
Employees should use this form to enroll in the Animal Exposure Occupational Medicine Program. Please follow all the instructions found on page one.
Download this form and open it from the saved location if you get a warning about needing to update your PDF viewer.
Initial Medical Questionnaire for Students with Animal Contact
Students should use this form to enroll in the Animal Exposure Occupational Medicine Program. Please follow all the instructions found on page one.
Download this form and open it from the saved location if you get a warning about needing to update your PDF viewer.
Follow-Up Medical Questionnaire for Employees with Animal Contact
Employees, use this form to update your medical information in the Animal Exposure Occupational Medicine Program. This form should be used if there are changes to your health or allergy status after you have completed the Initial Medical Questionnaire above.
Please follow all the instructions found on page one.
Download this form and open it from the saved location if you get a warning about needing to update your PDF viewer.
Follow-Up Medical Questionnaire for Students with Animal Contact
Students, use this form to update your medical information in the Animal Exposure Occupational Medicine Program. This form should be used if there are changes to your health or allergy status after you have completed the Initial Medical Questionnaire above.
Please follow all the instructions found on page one.
Download this form and open it from the saved location if you get a warning about needing to update your PDF viewer.
Hepatitis B Declination Form
Use this form if you have occupational exposure to bloodborne pathogens and you DO NOT want to receive the Hepatitis B vaccination. This form must be filled out and sent to EH&S.
Filling out this form does not prevent you from requesting the vaccination at a later date.
Informed Refusal for Medical Evaluation
Use this form if you are injured at work and you choose not to go immediately to a medical professional for evaluation. This form should be sent to EH&S when you submit an incident report.
This form does not prevent you from seeking medical attention at a later time for this injury.
Information for Persons Voluntarily Using Respirators
Fill out this page if you are voluntarily using a respirator at Eastern. It is used to ensure you understand what voluntary use of a respirator is and the benefits and hazards associated with this decision. Keep a copy for your records and send a copy to EH&S.
Alphabetical List of Forms
- Abandoned Lock/Tag Removal Form – from Electrical Safety page
- Aerial Lift Pre-Inspection Form – from Working From Heights & Fall Protection page
- Analytical X-ray Monthly Survey Record – from Radiation Safety page
- Analytical X-ray Daily Use Log – from Radiation Safety page
- Anatomy Lab Waste Disposal Procedure
- Anchorage Connector Inspection Form – from Working From Heights & Fall Protection page
- Biohazard Work In Progress Door Sign – from Biological Safety page
- Biosafety Manual – from Biological Safety page
- Building Captain/Floor Manager Application Form – from Building Captain Program page
- If you want to download a paper copy, click here.
- Confined Space Entry Permit – from Confined Space page
- Dorm Weekly Fire Extinguisher Checklist – from Dorm Safety page
- Equipment Inventory Form – from Electrical Safety page
- Fall Protection Work Plan – from Working From Heights & Fall Protection page
- Follow-Up Medical Questionnaire for Employees with Animal Contact -from Occupational Medicine page
- Follow-Up Medical Questionnaire for Students with Animal Contact -from Occupational Medicine page
- Generator Inspection Record – from Information for Waste Generators page
- Group Lockout/Tagout Procedure Worksheet – from Electrical Safety page
- Harness Inspection Form – from Working From Heights & Fall Protection page
- Hazard Door Sign Form – from Laboratories & Shops page
- Hazard Registration Form – from Laboratories & Shops, Laboratory Safety and Shop Safety pages
- Hazardous Waste Pick-Up Request Form – from Hazardous Waste page
- Health and Safety for Individuals Working With Animals – from Occupational Medicine page
- Hepatitis B Declination Form – from Occupational Medicine page
- Horizontal Lifeline Inspection Form – from Working From Heights & Fall Protection page
- Hot Work Permit – from Confined Space page
- Incident Report Form for Students, Faculty, and Staff – from Incident Reporting page
- Incident Report Form for Visitors – from Incident Reporting page
- Individual Lockout/Tagout Procedure Worksheet – from Ladder Inspection Form – from Shop Safety page
- Information for Persons Voluntarily Using Respirators – from Occupational Medicine and Personal Protective Equipment pages
- Informed Refusal for Medical Evaluation – from Occupational Medicine page
- Initial Medical Questionnaire for Employees with Animal Contact – from Occupational Medicine page
- Initial Medical Questionnaire for Students with Animal Contact – from Occupational Medicine page
- Laboratory and Academic Shop Safety Work Practices for Equipment – from Laboratories & Shops page
- Lanyard Inspection Form – from Working From Heights & Fall Protection page
- Lift Operators Personal Equipment Use Log – from Working From Heights & Fall Protection page
- Lockout/Tagout Equipment Specific Procedure – from Electrical Safety page
- Part-Time, Temporary and Student Health & Safety Orientation Form – from Occupational Health & Safety page
- Regulated Chemical Use Questionnaire – from Chemical Safety and Occupational Medicine pages
- Safety Concern Report Form – from Incident Reporting page
- Sattelite Accumulation Area Weekly Inspection Log
- Self-Retracting Lifeline Inspection Form – from Working From Heights & Fall Protection page
- Service Request Form– from Incident Reporting page
- Tagout-Only Justification Form – from Electrical Safety page
- Training Documentation Form
- Vertical Lifeline Inspection Form – from Working From Heights & Fall Protection page
- Waste Evaluation Request – from Hazardous Waste page
- Waste Pick Up Request – from Environmental Programs page
- Weekly Fire Extinguisher Checklist – from Dorm Safety page
