Forms

A Confined Space Permit must be completed if the space: * has the potential to contain a hazardous atmosphere;

• contains a material to engulf someone who enters the space or has an internal configuration that might cause an entrant to be trapped or asphyxiated; and

• contains any other recognizable physical (steam or electricity) or mechanical hazard (moving machinery parts.)

The “Confined Space Permit” must be completed and authorized by an OSHA trained individual and faxed to EH&S at (304) 293-7257.

The “Confined Space Permit” is limited to the date and time specified on the permit.

Facilities Management form used to notify building supervisor of scheduled work on Fume Hoods in their building.

Hazardous Chemical Disposal Form
On-Line
Acrobat (pdf)

To be filled out by any WVU personnel responsible for generation of unwanted Hazardous Materials. The form must be filled out completely, legibly, and accurately in order for EHS to schedule a pickup of the material(s). The form may be submitted on-line or via mail or fax. On-line submission is preferred.

Excel Spreadsheet to be used by individuals who utilize hazardous chemicals in their laboratory or work area. This inventory must be completed annually and forwarded in electronic format to

The Hotwork Permit is required for any operation involving open flames or producing heat and/or sparks. This includes, but is not limited to: Brazing, Torch Cutting, Grinding, Soldering, Thawing frozen pipes, Torch- applied Roofing, Welding, and CAD Welding.

The “Hot Work Permit” must be completed and authorized by an OSHA trained individual and faxed to EH&S at (304) 293-7257.

If Hot Work takes place in a Confined Space, a Confined Space Permit must also be completed.

To be completed by the supervisor to report the injury/occupational illness of an employee. Form must be completed within 24 hours or first working day after incident. Form must be printed, signed, and mailed to:

Environmental Health and Safety
ATTN: Injury/Illness Prevention Program
PO Box 6551
Morgantown, WV 26508

Completed by the supervisor for employees who work in areas that may contain hazards to determine the appropriate type of Personal Protective Equipment needed by the employee. These hazards include, but are not limited to:

• chemical,
• physical (heat, cold, radiation, etc.), and
• mechanical.

Copy must be forwarded to Environmental Health and Safety upon completion.

To be filled out by the supervisor when employee returns after being on leave due to an injury/occupational illness.

To be filled out by any WVU personnel after a potentially harmful substance has been released (spilled) into the environment and/or workplace. Mail, fax, or E-mail the form to:

Environmental Health and Safety
PO BOX 6551
Morgantown, WV 26506
Fax: 304-293-7257

This form is completed by the employee to determine their training needs. Once completed the form should be mailed to:

Environmental Health and Safety
Training
PO Box 6551
Morgantown, WV 26506

Training Registration Form

On-line registration form to be filled out by the employee wishing to attend training. The employee will be registered once the form has been received by Environmental Health and Safety. The contact information will be used to notify employees of any changes to the training.

NOTE: This form is not required for Driver’s Safety Training. Driver’s Safety Training is an on-line only course and no pre-registration is required.