Forms & Registrations
October 04, 2018

Accident/Incident Report - GTP (Webform)

All injuries must be reported immediately. Supervisors must complete this incident report and submit it to EHRS within two business days. 

Please note, this is the form for GTP. If you are looking for the (unrelated) Accident/Incident report for ULAR, go here.

Accident/Incident Report - GTP (Webform)

Forms & Registrations
August 14, 2018

Lab Safety Event Data Collection Form

Revision 9/2019

Report all Lab Safety Events (incidents, exposures, near misses, etc.) to EHRS by phone as soon as possible. 

Do not use this form until you have notified EHRS of the safety event and have been instructed by an EHRS staff member to complete the form.

All lab safety events (incidents, near misses, etc.) require the completion of the Lab Safety Event Data Collection Form, which can be downloaded at the link below. 

The intention of this form is to collect complete information as soon as possible so that EHRS can best understand how we can prevent...

Forms & Registrations
April 18, 2018

Chemical Inventory Training Request (Webform)

To request a non-mandatory training session for the Chemical Inventory system, please complete the form.

We recommend you review the ChemTracker User Guide before deciding whether you need a training session.

Chemical Inventory Training Request Form

Forms & Registrations
April 18, 2018

Hepatitis B Vaccination Request (Webform)

Due to your occupational exposure to blood and other potentially infectious materials, you may be at risk of acquiring hepatitis B virus (HBV) infection. Hepatitis B vaccination is available to you at no charge from Occupational Medicine. To request a vaccine, fill out the form below. Additionally, request a letter of authorization from your Business Administrator which includes your name and outlines a list of authorized services. Send the letter to Tara Byrd at Tara.Byrd@uphs.upenn.edu to schedule an appointment. Once services have been rendered, Occupational Medicine will issue an...

Forms & Registrations
April 18, 2018

Non Mercury Thermometer Request (Webform)

Thermometer exchanges cannot be processed unless all contact information has been submitted. Please dispose of all your mercury thermometers even if you do not need the same number of replacements.

Non Mercury Thermometer Request

Forms & Registrations
April 18, 2018

Warning Sign and Label Request (Webform)

Includes:

Microwave Sign(s)
Ice Machine Sign(s)
Refrigerator Label(s)
Hydrofluoric Acid Caution Sign(s)
Biohazard Label(s)
Chemically Contaminated Sharps – Do Not Autoclave,
Cold Room Notice Sticker
UV Caution Labels
Glassware Disposal Labels
Chemical Inventory Barcode Labels

 

Warning Sign and Label Request Form

Forms & Registrations
April 18, 2018

Room Sign Request (Webform)

Each laboratory has a room sign that provides safety information to visitors and housekeeping personnel. The principal investigator is responsible for assuring that appropriate warning information is included on this sign.

Room Sign Request Form

Forms & Registrations
April 18, 2018

Laser Warning Sign Request (Webform)

Each laboratory has a room sign that provides safety information to visitors and housekeeping personnel. In addition, Class 3b and 4 laser labs must also have signs that meet ANSI Z136.1–2014 requirements. The principal investigator is responsible for assuring that appropriate warning information is included on the sign. Please allow 2-4 weeks for processing.

Laser Warning Sign Request

Forms & Registrations
April 18, 2018

Accident/Incident Report - ULAR (Webform)

All injuries must be reported immediately. Supervisors must complete this incident report and submit it to EHRS within two business days. 

Please note, this is the form for ULAR. If you are looking for the (unrelated) Accident/Incident report for FRES, go here.

Accident/Incident Report - ULAR

Forms & Registrations
April 18, 2018

Chemical Storage Sign Request (Webform)

All chemical storage cabinets located in hallways must be adequately placarded to permit the identification of the cabinets contents and owner. The principal investigator is responsible for assuring that appropriate warning information is included on this sign.  Signs will be returned in 3 to 4 weeks.

Chemical Storage Sign Request Form

Forms & Registrations
April 18, 2018

New Faculty Registration (Webform)

Please complete the registration information.  All fields are required.  Upon submission, you will be directed to the New Faculty Overview page assembled to assist you in setting up a safe laboratory.

New Faculty Registration

Forms & Registrations
April 18, 2018

Student Training: Registration (Webform)

Training Registration Form for High School & Undergraduate Students Working in Labs

Training Registration for Non-Affiliates Working in Penn Labs during the Summer

Forms & Registrations
April 18, 2018

Contact the Ergonomics Staff (Webform)

If you are interested in evaluating office chairs or computer workstation accessories (mice, keyboard trays, standing workstations), you will be asked to make an appointment to visit the EHRS ergonomics room.  EHRS has a variety of equipment to try.  While we do not purchase chairs or equipment, we can provide cost and vendor information. 

If you are interested in a workstation evaluation, you will be asked to provide one or more photos of you working at your desk and details about your health concerns. An ergonomist will review the photos and provide recommendations.  In some...

Forms & Registrations
April 18, 2018

Dosimeter / Badge Request (Webform)

To learn more about radiation dosimeters, visit our Personnel Monitoring page.

Employees who have been issued dosimeters may contact EHRS (215-898-7187) to review their individual record of doses received.

Dosimeter / Badge Request Form

Forms & Registrations
April 18, 2018

Lock Box Request (Webform)

To order a lock box, please fill out and submit the form. Lock boxes are clear acrylic. They may be picked up at our lab in 421 ANAT/CHEM between 10:00 a.m. – 12:00 p.m. Monday through Thursday and 1:30 p.m – 3:00 p.m. Fridays. The price of the box will be charged to your account. If you have any questions please contact Eileen Normoyle at 215-898-2134. As a reminder, all stock material must be locked when in storage. The lock box must be secured to the refrigerator/cabinet.

Lock Box Request Form

Forms & Registrations
April 18, 2018

RAM Protocol Summary (Webform)

Please submit one form for each proposed use. Protocols involving animals and the use of radioactive materials, irradiators, or x-rays machines are reviewed and approved by the Radiation Safety Committee and the Institutional Animal Care and Use Committee (IACUC). Please see the User's Guide for additional information.

RAM Protocol Summary Form

Forms & Registrations
February 14, 2018

Hazard Control Plan Template

Revision 3/2019

A Hazard Control Plan (HCP) is a standard operating procedure for a specific process performed in your laboratory or department.  The HCP describes the hazardous materials or equipment in use and details the controls that will be put in place to minimize risk of exposure, injury, and other incidents.  While the HCP may also include experimental procedures, its purpose is primarily to document the hazards and controls for the process.  An HCP is typically written for procedures with particularly high hazards or when new hazards are introduced for the first time.  A...

Forms & Registrations
January 19, 2018

Job Safety Analysis (JSA)

Job Safety Analysis (JSA) is an important accident prevention tool that works by finding hazards and eliminating or minimizing them before the job is performed and before they have a chance to become accidents.

Forms & Registrations
November 09, 2017

Laser Eye Exam Form

For anyone who is required to have a baseline eye examination that conforms to ANSI Z136.1-2000.  Baseline eye examinations are not required under the ANSI Z136.1-2014 standard.   

Forms & Registrations
November 02, 2017

Hot Work Permit

This hot work permit is required for any temporary operation involving open flames or producing heat and/or sparks.  

Forms & Registrations
November 02, 2017

Accident/Incident Report - FRES

All injuries must be reported immediately. Supervisors must complete this incident report and submit it through their Management to the FRES Director of Safety within two business days.

Please note, this is the form for FRES.  If you are looking for the (unrelated) Accident/Incident report for ULAR, go here.

Forms & Registrations
November 01, 2017

Cs-137 Irradiator Access Request Form (Webform)

Each employee or student needing to use an irradiator must complete an application and receive approval from Environmental Health and Radiation Safety. Please see the User's Guide for additional information.

Irradiator Access Request Form

Forms & Registrations
November 01, 2017

Iodination Log

Iodinations may be performed only if approved as a special condition on your license. Iodinations may be performed only in fume hoods that have been approved by EHRS. Iodinators must log in the information immediately following an iodination. An iodination log must be posted on each approved fume hood. Please see the User's Guide for additional information.

Forms & Registrations
November 01, 2017

RAM Sewer Disposal Log

Sewer disposal must be recorded for all activity disposed. Only material that is readily soluble in water (or readily dispersible biological material) may be disposed of into the sanitary sewer. Liquids disposed to the sink must not contain chemicals regulated as hazardous, carcinogens, or mutagens. This log should be posted in the vicinity of the sink used for disposal. Required lab record for RAM users. Please see the User's Guide for additional information.

Forms & Registrations
November 01, 2017

ALARA Training

Each licensee is required to provide ALARA training to the lab staff before they work with radioactive materials and then annually. In addition to online EHRS training, each licensee must hold an in-lab training session to review their experimental protocols, work habits, and available safety equipment for adherence to the ALARA policy. Documentation of an ALARA training session is required annually. Required lab record for RAM users. Please see the User's Guide for additional information.

Forms & Registrations
November 01, 2017

RAM Receipt and Inventory Log

Each laboratory must maintain a strong inventory and accountability system. Your inventory log should enable you to continually track incoming shipments of material and account for its use, transfer, and disposal. Required lab record for RAM users. Please see the User's Guide for additional information.

Forms & Registrations
November 01, 2017

RAM Lab Monitoring Form

Labs should be checked for contamination after each use of RAM. At least one such survey must be recorded WEEKLY. If no RAM is used in a given week, an entry of "No RAM Use" must be recorded. Required lab record for RAM users. Please see the User's Guide for additional information.

Forms & Registrations
November 01, 2017

RAM License Amendment (Webform &PDF)

Licensees who wish to amend radionuclides, activity limits, rooms, or complete a license inactivation must complete this form. A Protocol Summary Form is also required if the license change is due to addition of an isotope or an increase in activity being used. Please see the User's Guide for additional information. If you would like to automatically submit the form, a Webform is also available for the RAM License Amendment Form.

Forms & Registrations
November 01, 2017

Radioactive Material License Application

Form for faculty members seeking license approval to use radioactive materials. All use of radioactive material must be done under the supervision of a Licensee who has been approved/licensed by the Radiation Safety Committee (RSC). Each Licensee is responsible for the health and safety of persons using RAM under his/her license, assuring that workers are properly trained, and assuring that work is done in accordance with relevant policies and procedures. Please see the User's Guide for additional information.

Forms & Registrations
October 31, 2017

Exposure Control Plan

Penn's Bloodborne Pathogens Exposure Control Plan (ECP)

All Penn faculty, staff and students in clinical, research, and non-research areas who may reasonably anticipate occupational exposure to human bloodborne pathogens (BBP) or other potentially infectious materials (OPIM) must comply with the OSHA Bloodborne Pathogen Standard.

All research personnel who have the potential to be exposed to BBP or human source material, including primary and established cell lines, blood products, body fluids, and tissue must have a lab-specific ECP on file with EHRS.

Non-research...

Forms & Registrations
October 31, 2017

REQUEST for VACCINIA (Smallpox) VACCINE

The Centers for Disease Control distributes Vaccinia Vaccine to physicians for immunization of laboratory personnel who are working with orthopox viruses. The vaccine must be administered by or under the supervision of a licensed physician.  To initially receive the vaccine theentire form must be completed and returned along with the FDA form 1572 (Statement of Investigator) to the address listed on the form.

Forms & Registrations
October 31, 2017

Safety Programs and Policys

Asbestos Management Program
Confined Space Program
Elevated Work Platforms
Electrical Safety Programs
Fall Protection Program
Hazard Communication Program
Hearing Conservation Plan
Heat Stress Program
Control of Hazardous Energy Program
Machine and Powertool Safety
Respiratory Protection Program