Forms

Documents on this page can be accessed by clicking on the blue links below. 

If you cannot download or view the listed file(s), please contact SH&S at (760) 750-4502 or hgarcia@csusm.edu and we will assist you.

Biological Safety

• Biohazardous Waste Generator Labels (Use Avery 5160)
• Research & Biological Material/Tissue Transfer (RBMT) Request Form

Chemical Safety

Defensive Driving

• Authorization of Use Private Vehicle - STD 261
• Authorization for Release of Driver Record Information - INF1101
• Vehicle Accident Reporting Form - STD 270
• State Driver Accident Review - STD 274

Ergonomic Safety

• Ergonomic Self Evaluation
• Ergonomic Support Tool & Equipment Reimbursement Form

Food Safety Program

• Online Application for Temporary Food Permit
• Application for Temporary Food Permit: On Campus Group (pdf)
• Application for Temporary Food Permit: Off Campus Group (pdf)

Incident/Accident Investigation

Instructions: This form is to be completed immediately upon learning of an employee's accident or incident. The form is to be completed thoroughly by the employee's Appropriate Administrator. Upon completion, return the form via email to: shs@csusm.edu and edikitanan@csusm.edu.

• CSUSM Employee Accident/Incident Form
• CSUSM Non-Employee Accident/Incident Form

Laboratory Safety

• Laboratory Self-Inspection Checklist

Occupational Safety

• Employee Safety Reporting Form (Anonymous)
• Initial Investigation - IIPP Form 5
  
  • Addt'l Space Form - IIPP Form 5
• Witness Statement - IIPP Form 5
• Corrective Action - IIPP Form 5b
• Employee Training Sign-In Form - IIPP Form 6
• Incident Response Form
• Indoor Air Quality Survey
• Occupant Diary
• Smoking Policy Violations
• Job Safety Analysis (JSA) Form
  • Directly download the form onto your PC and fill out using Adobe Acrobat Pro

Radiation Safety

• Radiation Survey Form