Environmental Health & Safety Forms

Campus & Clinical Safety Forms

BMC OEM Respiratory Questionnaire

Complete and submit to Research Occupational Health for a respirator medical clearance.

Download Form

BU ROHP Respiratory Questionnaire

Complete and submit to Research Occupational Health for a respirator medical clearance.

Download Form

Ergonomics Self-Assessment

Provides information to set up an ergonomic workstation.

Complete Online Form

Fit Test Sign-Up Form

Complete to attend one of the scheduled monthly fit test sessions.

Complete Online Form

Request an Asbestos Evaluation

Request an asbestos evaluation from EHS.

Complete Online Form

Near Miss Reporting

Report a Near Miss to EHS.

Complete Online Form

Controlled Substance Forms

Controlled Substance Authorization Form (#1)

Controlled Substance Authorization form is required for all Principal Investigators (PI) who seek privileges to conduct research with controlled substances. The PI will seek privileges for his/her lab personnel and define their role (Authorized Handler and/or Authorized Transporter).

Download Form

Controlled Substance Requisition Form (#2)

Controlled Substance Requisition form is required for each controlled substance order.

Download Form

Controlled Substance Update Form (#4)

Controlled Substance Update form is required for annual updates or when you need to remove personnel from your roster of authorized handlers.

Download Form

Controlled Substance Transfer Form (#5)

Controlled substance Transfer form is available should you need to transfer a CS to a BU affiliate. All transfers must be approved by the CSO. Strict record keeping and security measures are required for all aspects of receipt, use, storage and disposal.

Download Form

Controlled Substance Diversion Form (#6)

Upon obtaining privileges to store and use CS, the PI is responsible for keeping and maintaining an updated inventory of all CS he/she has ordered, received, used and disposed of. The Controlled Substance Diversion form must be used to report all diversions, loss or any non-compliance immediately to the CSO once the registered PI or those authorized under him or her first become aware or has occurred within 24 hours.

Download Form

Controlled Substance Waste Disposal Form (#7)

As part of the security requirements, the registered PI must surrender all wasted CS and expired/unwanted CS to CSP@bu.edu. Document your surrender in the CS logbook and on the Controlled Substance Waste Disposal form.

Download Form

Dive Safety Forms

AAUS Medical Dive Form

For every scientific diver seeking medical clearance for scientific diving under AAUS guidelines, this form must be completed by a physician and returned to the dive safety officer.

Download Form

BU Dive Plan Form

For any scientific dive supervisor seeking authorization for a particular dive site, this form must be completed and returned to the dive safety officer.

Download Form

BU Diving Program: Informed Consent Form

Informed consent and liability release form.

Download Form

BU Diving Program: Insurance and Waiver Form

Insurance information and waiver.

Download Form

BU Diving Program: Medical Care Authorization Form

Emergency medical care authorization.

Download Form

BU Diving Program: Medical Information Form

Emergency Response Planning

Continuity of Operations Plan (COOP) Template

Template for development of a continuity of operations plan.

Download Form

COOP Contents

Critical Business Functions

Use this form to identify the business function(s) critical to your operation(s).

Download Form

Guide to Prepare for COOP

Spreadsheet guide to prepare a continuity of operations plan.

Download Form

Recovery Location

Use this form to provide information on your recovery location, that is, where you will conduct business operations following a crisis event.

Download Form

Recovery Template

Recovery template.

Download Form

Environmental Waste & Management

Medical Campus: Hazardous Chemical Waste Pickup Request

Use this form to request a chemical waste pickup on the Medical Campus or at BMC.

Complete Online Form

Charles River Campus: Hazardous Chemical Waste Pickup Request

Use this form to request a chemical waste pickup on the Charles River Campus.

Complete Online Form

Charles River Campus: Biological Waste Pickup Request

Use this form to request a biological waste pickup on the Charles River Campus.

Complete Online Form

Radioactive Waste Pickup Request

Use this form to request a radioactive waste pickup.

Complete Online Form

Laser Safety

Laser Disposal Form

For the disposal of all Class IIIB or IV lasers.

Download Form

Laser Permit Application

For any investigator planning to work with Class IIIB or IV lasers.

Complete Online Form

Laser User Certification Form

For any user listed on authorized personnel on a laser permit, this form must be completed and signed.

Download Form

Medical Physics & Radiation Safety

Application to Use Radioisotopes in Animals

For any investigator planning to work with radioisotopes in animals.

Download Form

Authorized User Responsibilities

For the written acceptance of responsibilities while using radioactive materials. Required of all personnel on a radioactive material permit.

Download Form

BU Radioisotope Posting

Area posting for radioactive materials laboratories detailing guidelines of radioactive materials usage.

Download Form

Declaration of Pregnancy

For radiation workers to declare a pregnancy and receive fetal dosimetry (RSO interview required).

Download Form

Dosimetry Request

For requesting radiation monitoring dosimetry.

Download Form

DPH Notice to Employees

Area posting for radioactive materials laboratories detailing MA-DPH regulations.

Download Form

Irradiator Request

For reserving an irradiation time slot.

Complete Online Form

Irradiator User Responsibilities

For completion by all users authorized to use the irradiator unattended.

Download Form

Lab Supervisor Responsibilities

For the written acceptance of responsibilities as laboratory supervisor of a radioactive materials laboratory. Required of the laboratory supervisor on a radioactive material permit.

Download Form

Laboratory/Equipment Decommissioning

For requesting the release of equipment or laboratory spaces used with radioactive materials.

Complete Online Form

Permit Holder Responsibilities

For the written acceptance of responsibilities as a permit holder of a radioactive material permit. Required of the permit holder of a radioactive material permit.

Download Form

Radioactive Material Permit (Human Use) Application

For completion by investigators who are planning to work with radioactive materials in humans.

Download Form

Radioactive Material Permit (Non-Human Use) Application

For completion by investigators who are planning to work with radioactive materials not in humans.

Download Form

Radioactive Material Permit (Non-Human Use) Renewal & Changes

For completion by investigators who need to change or renew their radioactive material permit.

Download Form

Radioactive Material Use & Inventory Log

For inventorying and tracking usage of radioactive materials.

Download Form

Radioactive Sink Disposal Limits

Area posting detailing the acceptable quantities of radioactive material sink discharge.

Download Form

Radioactive Waste Disposal Record

For logging radioactive materials disposal.

Download Form

Radioisotope Permit Application

For any investigator planning to work with radioisotopes.

Log in to RIMS to Complete

Radioisotope Purchase Form

For the ordering of radioactive materials and kits.

Complete Online Form

Radioisotope User Certification Form

For detailing the presentation and acknowledgment of safety responsibilities while using radioactive materials.

Download Form

Radiological Equipment Purchase Form

For purchasing equipment related to radioactive materials detection, storage, or shielding.

Complete Online Form

RAM Sink Disposal Log

For logging the sink discharge of radioactive materials.

Download Form

Research Safety Forms

Job Hazard Analysis Form

This document is a tool to help you build your lab-specific trainings and standard operation procedures and identify gaps in process and safety.

Download Form

Laboratory or Equipment Decontamination Certification Form

The principal investigator or laboratory safety coordinator must complete the Laboratory or Equipment Decontamination Certification and submit the form to the EHS departmental safety advisor when decontamination and decommissioning activities are completed. This will allow EHS personnel to review the decommissioning activities, visit the laboratory, and alert the appropriate administrative personnel that the decommissioning has been performed.

Download Form

Minors in Laboratories Policy & Form

No person under the age of 18 should be allowed to visit a laboratory without the expressed, written permission of Environmental Health & Safety by the use of this form.

Download Form

New Lab Personnel Guide

This guide provides items to consider when welcoming new members to your lab.

Download Form