Special Resources » Forms: Environmental Health & Safety


Download forms for workplace safety and health. Examples: job hazard analysis forms, confined entry permit form, TRI forms, building evacuation plan form, JCAHO medical errors reporting form, ergonomics cost / benefit form, etc.

The following is the collection of special resources throughout the library. Click on main category / sub-category for that section of the library OR Click on resource title for immediate access to the resource.
Driver Safety » Driver Policies
Sample fleet-related company policies - vehicle use, drivers, seat belts, etc.

Central Fleet Administration Forms [23620] Central Fleet Administration Forms : Resource Info
Sample forms to be used in fleet administration

MVR Statement [pdf] [16147] MVR Statement : Resource Info
Sample form that can be signed by a driver acknowledging MVR point system policies

VA-Virginia Office of Fleet Management Services [19671] VA-Virginia Office of Fleet Management Services : Resource Info
Fleet rules and regulations for state agencies in Virginia

Driver Safety » MVR Points
Guidance on driver selection criteria, what to look for in an MVR

AR-Arkansas State Vehicle Safety Program [doc] [17550] AR-Arkansas State Vehicle Safety Program : Resource Info
Point system used for the state's fleet drivers - including sample forms

NC-North Carolina Forms for Driver License [15893] NC-North Carolina Forms for Driver License : Resource Info
The Driver Privacy Protection Act - Form 1 required

OH-Ohio Driving Records [15877] OH-Ohio Driving Records : Resource Info
Forms for ordering MVR records in Ohio - consent forms, etc.

Emergency Preparedness » Emergency Plans
Examples of emergency management and action plans

School Emergency Preparedness Plan & Forms [8864] School Emergency Preparedness Plan & Forms : Resource Info
This two volume model program can be adapted to the needs of your site

HR Forms » Symptom Surveys
Ergonomics medical symptom survey questionnaires

Ergonomics Evaluation Form [148] Ergonomics Evaluation Form : Resource Info
Employee checklist for medical symptoms from computer workstations

Ergonomics Symptom Survey [23908] Ergonomics Symptom Survey : Resource Info
Download a sample form

Sample Worker Ergonomics Symptoms Questionnaire [19244] Sample Worker Ergonomics Symptoms Questionnaire : Resource Info
Questions use a five point or ten point scale

HR Management » HR Costs
Costs of hiring, turnover, absenteeism, etc.

Business Safety Incident Calculation Worksheet [pdf] [31581] Business Safety Incident Calculation Worksheet : Resource Info
To assist in calculating the anticipated and unexpected costs associated with a workplace safety incident

Workplace Injury Cost Calculator Worksheet [31579] Workplace Injury Cost Calculator Worksheet : Resource Info
Helps to identify actual costs related to a workplace injury

Office Safety » Chair Use
Chair selection criteria, seated postures, tips on chair adjustment, etc.

Ergonomic Seating Evaluation Form [pdf] [19240] Ergonomic Seating Evaluation Form : Resource Info
A worksheet to help you gather information on the quality of chairs being assessed

Office Safety » Computer Use
Computer use hazards and guidelines

Ergonomic Keyboard & Mouse Platform Systems Evaluation Form [19241] Ergonomic Keyboard & Mouse Platform Systems Evaluation Form : Resource Info
Worksheet to help you gather information on the quality of keyboard & mouse platforms being assessed

Office Safety » Office Safety Program
Checklists, office safety programs, training materials, home offices, etc.

Office Safety Analysis [18951] Office Safety Analysis : Resource Info
Office safety checklist

Office Safety Checklist [pdf] [18882] Office Safety Checklist : Resource Info
Sample office safety checklist and instructions

Office Safety Checklist for Visually Impaired [26888] Office Safety Checklist for Visually Impaired : Resource Info
A basic office safety checklist

OSHA » Accident Investigation
Accident investigation programs, job safey analyses, etc.

Updated Accident Investigation Report [15580] Accident Investigation Report : Resource Info
Sample form and instructions

Accident/Illness Reporting and Recording Procedures & Forms [pdf] [18903] Accident/Illness Reporting and Recording Procedures & Forms : Resource Info
Sample procedures and forms in use by a US government agency

Job Hazard Analysis [8334] Job Hazard Analysis : Resource Info
Basics of job hazard analysis process with sample forms

Supervising Accident Repeaters [pdf] [18783] Supervising Accident Repeaters : Resource Info
Sample accident review form and guidance (pdf)

Updated Supervisor's Accident Investigation [pdf] [26819] Supervisor
What to look for

OSHA » OSHA Forms
Download OSHA logs and forms for workplace injury recordkeeping requirements, co

MSHA Forms [28181] MSHA Forms : Resource Info
Mine Safety and Health Administration - Download the forms and the instructions

OSHA Forms [3548] OSHA Forms : Resource Info
Forms to be used for calendar year 2004 and beyond

OSHA Logs [xls] [24171] OSHA Logs : Resource Info
Download US Federal OSHA Forms in Microsoft Excel format

OSHA Online Complaint Form [23931] OSHA Online Complaint Form : Resource Info
Notice of Alleged Safety or Health Hazards

OSHA Recordkeeping Forms [21072] OSHA Recordkeeping Forms : Resource Info
Download OSHA 300 forms

OSHA Worker Complaint Form [21073] OSHA Worker Complaint Form : Resource Info
File a complaint online or download the OSHA complaint form

OSHA-171 Grantee Quarterly Progress Report [28180] OSHA-171 Grantee Quarterly Progress Report : Resource Info
Download the form and the instructions

OSHA-182 Student Data Form [28179] OSHA-182 Student Data Form : Resource Info
Download the form and the instructions

OSHA-49 Course Evaluation [28178] OSHA-49 Course Evaluation : Resource Info
Download the form and the instructions

OSHA-7 Form Notice of Alleged Safety and Health Hazards [28177] OSHA-7 Form Notice of Alleged Safety and Health Hazards : Resource Info
Download the form and the instructions

OSHA » OSHA Recordkeeping
OSHA recordkeeping guidelines, standards, fact sheets, etc.

Cal/OSHA Forms 300, 300A, 301 [8134] Cal/OSHA Forms 300, 300A, 301 : Resource Info
Download the injury and illness forms

MI-Michigan MIOSHA Recording and Reporting Requirements [3937] MI-Michigan MIOSHA Recording and Reporting Requirements : Resource Info
How to complete MIOSHA forms 300, 300A and 301

OR-OSHA Recordkeeping [7915] OR-OSHA Recordkeeping : Resource Info
Everything you need for OSHA recordkeeping in the State of Oregon

OSHA » OSHA Violence
OSHA technical resources on violence in the workplace

Sample Workplace Violence Prevention Program [9665] Sample Workplace Violence Prevention Program : Resource Info
Sample workplace violence program, checklist, incident report form

OSHA » Safety Committees
Safety committees, safety teams, etc.

Sample Safety Committee Meeting Report & Guidelines [pdf] [18775] Sample Safety Committee Meeting Report & Guidelines : Resource Info
Provides guidance for safety committees and a sample form (pdf)

OSHA » Safety Programs
OSHA technical resources on safety programs, including motor vehicle safety

OSHA Small Business Handbook [pdf] [27022] OSHA Small Business Handbook : Resource Info
Covers a wide variety of workplace safety program topics including self-inspections

Security » Bomb Threats
Bomb threat and physical security planning

Bomb Threat Telephone Procedures [pdf] [26472] Bomb Threat Telephone Procedures : Resource Info
Checklist on what questions to ask of the caller (pdf)

Software » Environmental Software
Download software for EPA safety & health programs, site-specific sampling

TRI-ME Reporting Software [3652] TRI-ME Reporting Software : Resource Info
Toxics Release Inventory – Made Easy (TRI-ME) software page

Software » Ergonomics Software
Ergonomics-related software available for downloading on the internet

Ergonomics Resources [25107] Ergonomics Resources : Resource Info
Ergonomics tools, data and documents for ergonomist use in workplace task analyses

Software » Safety Software
Download software related to workplace safety

MSHA Online Forms Advisor [10332] MSHA Online Forms Advisor : Resource Info
Designed to help those involved in the mining industry fulfill their filing requirements

US State Government » NH-New Hampshire
Access to state agencies and laws for the state of New Hampshire

Safety Summary Form - New Hampshire [17236] Safety Summary Form - New Hampshire : Resource Info
Download the form required to be filed biennially to the state Department of Labor - New Hampshire



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