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  • About Us
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  1. Nebraska
  2. Business & Finance
  3. University Services
  4. Environmental Health & Safety
  5. Resources
  6. Forms/Checklists

Forms

Accidents and Injuries

  • Employee's Choice or Change of Doctor Form
  • First Report of Alleged Occupational Injury or Illness
  • Prescription Program for Work-Related Injuries
  • Release To Return To Work
  • Supervisors Incident Analysis Report
  • Workers' Compensation Incident Report

Audits and Surveys

See Safety Audit Guidelines SOPs

Biosafety

  • Autoclave Log Sheet
  • Biosafety Manual Table of Contents Form

Bloodborne Pathogens

  • Declination Statement (EHS-BBP-02) (5/20)
  • Enrollment Checklist and Site-Specific Training Roster (EHS-BBP-04) (5/20)
  • Exposure Care Kit (EHS-BBP-03) (5/20)

Radiation Safety

  • Declaration of Pregnancy 
  • Radiation Training & Experience History and Personal Dosimetry
  • Specific Training Form (Practical) for Portable Gauge Users
  • Specific Training Form (Practical) for Non-Healing Arts Radiation-Generating Devices

Respiratory Protection

  • Hazard Assessment (EHS-RPP-01) (3/11)
  • Medical Evaluation Questionnaire (EHS-RPP-04) (10/16)
  • Medical Surveillance Assessment (EHS-RPP-05) (3/11)
  • Respirator Fit Test Record (EHS-RPP-03) (3/22)

Report an Accident

Report an Accident or Near-Miss

  • Student Injury/Illness Reporter
  • Near-Miss/Close Call Incident Reporting System
  • More about Employee Injury Reporting

EHS SAFETY LISTSERV

Subscribe to our EHS Safety Listserv

Stormwater Pollution Reporter

Stormwater Pollution Reporter

  • Stormwater Management: What Stormwater Management Is and Why It Is Important
  • Stormwater Pollution Reporting Form

Address3630 East Campus Loop
Lincoln, NE 68583-0824

Phone number402-472-4925

Fax402-472-9650

Emailehs@unl.edu (Main Department)

Emailrso@unl.edu (Radiation Safety)

Emailibc@unl.edu (Biosafety Committee)

Emailstormwater@unl.edu (Stormwater Issues)

Emailunl_Inventory@unl.edu (Inventory, Surplus & Asset Management Issues)

Emailbiosafety@unl.edu (Biosafety Issues)

Related Links

  • Satisfaction Survey
  • Subscribe to EHS Listserv / View Past Issues
  • Safety Posters

Campus Links

  • Directory
  • Employment
  • Events
  • Libraries
  • Maps
  • News
  • Office of the Chancellor
  • Report an Incident

Policies & Reports

  • Accessibility Statement
  • Emergency Planning and Preparedness
  • Institutional Equity and Compliance
  • Notice of Nondiscrimination
  • Privacy Policy
  • Security and Fire Safety Report
  • Student Information Disclosures
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