Forms
Biological & Laboratory Safety
- Decontamination Clearance (For Biological Safety Cabinets)
- Employee Specific Chemical Hygiene Training Form
- Engineered Nanomaterial Survey (Submit Online)
- Laboratory Decommissioning
- Laboratory Equipment Decontamination
- List of Registration Forms for Recombinant DNA - IBC
- New Researcher Partner (Submit Online)
- OSEH BL2 Recombinant DNA/Infectious Agent Inspection
- OSEH Laboratory Safety Checklist
- Machine Shop Safety Checklist
- Laser Safety Inventory and Inspection Sheet
- Reproductive Hazard Evaluation Form
- Toxin Declaration Form
- UN Certified Biological Shipping Systems Available (Submit Online)
Radiation Safety Forms
- Dosimeter Request
- Dosimeter Change/Deletion
- New Series Request Form
- RSS-101 Application for Authorization to use Radioactive Material
- RSS-101A Statement of Training and Experience
- RSS-101 Section 9 Form
- RSS-105 (Radioactive Contamination Survey Record)
- RSS105a - Declaration of Pregnancy
- RSS105b - Pregnancy Declaration Revocation
- RSS105c - Pregnancy Declaration Expiration
- Radionuclide Receipt, Utilization and Disposal Record Form
- Request for Room Additions and/or Deletions Form
- Annual Refresher Training Acknowledgment Form
UMHHC Dosimetry Forms
- New Series Request Form
- New Series Dosimetry Assessment Form
- Spare Dosimeter Form
- Dosimeter Request Form
- Dosimeter Modification/Deletion Form
- Declaration of Pregnancy Form (RSS-105A)
- Pregnancy Declaration Revocation Form (RSS-105B)
- Pregnancy Declaration Expiration Form (RSS-105C)
UMHHC Radiation-Generating Devices Forms
- Mammography Machine Registration Form
- Mammography Machine Modification/Deletion Form
- Radiation Producing Device Registration Form
- Radiation Producing Device Modification/Deletion Form
Special Request Forms
- Chemical Inventory System User Request Form
- Ergonomic Workstation Assessment
- For Ann Arbor campus employees complete the Ergonomics Services Request Form
- For Medical School employees complete the Ergonomics Services Request Form
- For Health System employees contact Safety Management Services at 764-4427
- Medical Surveillance Questionnaire Form
- Safety Shoe or Safety Glasses
