Radiological & Environmental Management Division of Environmental Health and Public Safety

REM Forms

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


A


B


agent inventory -pdf
agent inventory -word
image of document
Biological Agent Inventory -PDF

Biological Agent Inventory -Word

 

Biological Safety Awareness

image of form
image of form
image of form

Biomaterials Pickup Request

 

BBP- Hepatitis B Vaccination Declination

 

 BBP- Hepatitis B Vaccination Eligibility List

 

image of form

BBP- Training and Certification

 

C


Clickable link for CFATS Appendix A Inventory Form
clickable link to the CFATS data collection form
Clickable link for CHP Awareness Certification

CFATS- Appendix A Inventory

 

CFATS- Data Collection Form

CHP- Awareness Certification

clickable link to the compliance & risk reduction funding request form
clickable link to the confined space entry permit
clickable link to the confined space meter calibration form

Compliance & Risk Reduction Funding

Request

Confined Space Entry Permit Confined Space Meter Calibration
clickable link to the confined space training certificate
clickable link to the controlled substance administered/dispensed
clickable link to controlled substance authorized users list

Confined Space Training Cert.

 

Controlled Substance Admin/Disp

Controlled Substance Authorized Users

clickable link to controlled substance DEA form 222 use
clickable link to controlled substance physical inventory form
clickable link to controlled substance purchases form

Controlled Substance DEA Form 222 Use

 

Controlled Substance Physical Inventory

Controlled Substance Purchases

clickable link to the controlled substance security release form

Controlled Substance Security Release

 

D


E


office worker ergonomic questionnaire
excavation competent person evaluation
checklist

Ergonomic Questionnaire

Excavation Competent Person

 

Excavation Site Checklist

F


fire department confined space entry
first report of injury
temporary food service application
Fire Department C.S. Entry Notification First Report of Injury

Food Service Application (Temporary)

 

appendix d

Foodborne Illness & Allergy

G


request to access gamma irradiator

Gamma Irradiator Access Request

 

H


hazard assessment for electrical work
certification of hazard assessment -location
certification of hazard assessment position/title

Hazard Assessment -Electrical Work

Hazard Assessment -Location

Hazard Assessment -Position/Title

 

certification of hazard assessment single task
certification of hazard assessment template
hazard clearance & declaration form

Hazard Assessment -Single Task

 

Hazard Assessment -Template Hazard Clearance & Declaration
image of chemical inventory form
image of DTI certification form
image of hazcom program implementation

HazCom -Chemical Inventory

 

HazCom -DTI Certification HazCom -Program Implementation
hazard communication attendance record
image of hazard risk assessment form
hazardous material pickup request word

HazCom -Attendance Record

 

Hazard Risk Assessment Hazardous Material Pickup Request -PDF
image of hazardous material pickup request -word
Hazardous Materials Pickup request web submission
hazardous material shipment request

Hazardous Material Pickup Request -Word

 

Hazardous Material Pickup Request -Web Hazardous Material Shipment Request

I


indoor air quality concern
integrated safety plan certification audit
integrated safety plan self audit

Indoor Air Quality Concern

 

Integrated Safety Plan Certification Integrated Safety Plan Self-Audit
isotope use record sheet

Isotope Use Record Sheet

 

J


K


L


laboratory information
laser project application
loto

Laboratory Information

 

Laser Project Application LOTO- Exchange of LOTO Program
loto
loto
loto

LOTO- Periodic Inspection

 

LOTO- Training Certification LOTO- Work Plan

M


materials which must be reported to rem
materials which must be reported to rem -word

Materials Which Must Be Reported -PDF

 

Materials Which Must Be Reported -Word

N


non-permit confined space certification

Non-Permit Confined Space Cert.

 

O



osha compliance funding request

Compliance & Risk Reduction Funding

Request

P


permit confined space entry contractor debriefing
personal protective equipment certification of training
prescription safety glasses

Permit Confined Space Contractor Debrief

 

PPE Certification of Training Prescription Safety Glasses
presidential safety award nomination

Presidential Safety Award

 



Q


R


radiation facility approval request
radiation project approval request
radioactive materials and radiation producing devices use application

Radiation Facility Approval Req.

Radiation Project Approval Req.

Radioactive Mat./Radiation Producing Use App.

 

radioactive material requisition
radioactive material survey record
hazard clearance & declaration form

Radioactive Mat. Requisition

 

Radioactive Mat. Survey Record Radioactive Waste Log Sheet
clickable link to radioactive waste pickup request
appendix d
hepatitis b vaccination eligibility list

Radioactive Waste Pickup Request

 

Respirator Appendix D Respirator Inspection Record

respirator participation application

Respirator Participation Application

 



S


agent inventory -pdf
link to pdf of SDS compliance checklist
link to pdf of female self assessment

Safety Training Sign In Sheet

 

SDS Compliance Checklist Self-Assessment Survey -Female

link to pdf of left hand self assessment
link to pdf of male self assessment
link to pdf of right hand self assessment

Self-Assessment Survey -Left Hand

 

Self-Assessment Survey -Male Self-Assessment Survey -Right Hand

link to pdf of supervisor near miss report
Link to PDF document of Survey Meter Inventory

Supervisor's Acdnt/Near-Miss Investigation

 

Survey Meter Inventory

T


image of first page of training record -rpp
image of fist page of training attendance record -hcp

Training Record -RPP

 

Training Attendance Record -Haz Com

U


universal waste battery
universal waste lamp

Universal Waste: Battery Compliance

 

Universal Waste: Lamp Compliance

V


W


worker's compensation witness report form

Worker's Comp. Witness Report

 

X


Y


Z


  • forms
Campus Safety Contacts

call 911

If you see something, say something.

Purdue Police
Phone: (765) 494-8221

Purdue Fire
Phone: (765) 494-6919

REPORT A SAFETY CONCERN

Sign up for Emergency Text Messages

Carol Shelby, Senior Director

Phone:
(765) 494-7504
Email: 
cshelby@purdue.edu
Do you want to recognize one of our staff for a job well done? Nominate the staff member(s) for a Bravo Award here!

Purdue University Radiological & Environmental Management, 550 Stadium Mall Drive, West Lafayette, IN 47907, (765) 494-6371

© 2017 Purdue University | An equal access/equal opportunity university | Copyright Complaints | Maintained by Radiological & Environmental Management

If you have trouble accessing this page because of a disability, please contact the Office of Institutional Equity at equity@purdue.edu.