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: The Employee form is to be completed immediately upon learning of an employee's accident or incident 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