Forms
Aerial Lift
Emergency Procedures
Administered by UVA Emergency Management
Contractor Safety Acknowledgement
Fall Protection
Inspections
Correct inspection procedures can prevent incidents, injury/illness, and/or property/equipment damage.
Job Hazard Analysis
Permits
Permits are an essential tool for assuring safety during potentially hazardous work activities. The process guides the supervisor and employees through a systematic evaluation of the task to be completed.
Respirator Forms
If you have questions about your respirator or would like to request sampling or training, email FM-OHS@virginia.edu.
- Medical Evaluation Questionnaire
- KN95 Respirator Voluntary Use Form
- Non-Routine Respirator Use Plan
- OSHA Respirator Medical Evaluation Questionnaire
- Respirator Fit Test and Training
- Respirator Program Exit
- Respirator Use Information
- Respirator Voluntary Use Form
- Worksite-Specific Procedure for Voluntary Use of Filtering Facepiece Respirator
- Worksite-Specific Procedure for Use of Respiratory Protection
Safety Shoe Request
Sampling
Sampling and analysis is conducted on jobsites and at regular work tasks by an occupational health and safety professional to look for physical stressors, biological hazards and chemicals to ensure workplace safety. Email FM-OHS@virginia.edu if you have questions about this process.
Training
Workers Comp, Incident, and Near Miss
- Near Miss Report Form – Only use this form for incidents that did not result in injury. A near miss event is defined as an unintentional in nature, unsafe occurrence that could have resulted in an injury or fatality. Only a fortunate break in the chain of events prevented an injury, fatality, or damage.
- Workers’ Compensation/Accident-Injury Reporting Portal – includes online reporting form, checklists for employees/supervisors and quick facts.