Overview
The forms and checklists have been assembled from many different parts of the RMEHS Campus Programs. Where forms come from procedures, the procedure title and appendix are given. The Procedures are found in the RMEHS Procedures Manual. Most Emergency Preparedness checklists and forms are found in Emergency Preparedness.
Procedure Appendices
- Supervisor Safety Checklist (Confined Space App. B)
- Confined Space Entry Permit (Confined Space App. C)
- Non‐Permit Entry Certification (Confined Space App. D)
- High Voltage Switching Procedures & Receipt (Elect. App. A)
- Energized Electrical Work Permit (Elect. App. C)
- Safety Meeting Documentation Checklist (Elect. App. D)
- Emergency Checklist Form (AP 408 App. 8.3)
- Evacuation Drill Evaluation Form (AP 408 App. 8.4)
- Portable Fire Extinguisher Check Sheet (Fire Protect. App. A)
- Employee Report of Occupational Injury or Illness (IIPP App. 8.4)
- Hazard Incident Report Form (IIPP App. 8.2)
- Report a Safety Concern
- Supervisor Report of Occupational Injury or Illness (IIPP App. 8.3)
- Annual Ladder Inspection Form (Ladder Safety App. 9.1)
- Tele-Tower Scaffold Checklist (Portable Scaffold App 8.1)
- Perry Scaffold Checklist (Portable Scaffold App 8.2)
- LOTO Audit Form (LOTO App. B)
- Respirator Cleaning Log (Resp. Prot. App. A)
- Respirator Fit Test Log (Resp. Prot. App. B)
Note: The following components must be fulfilled in order to be respirator qualified.
- Training – Compliance Brief: Filtering Facepiece Respirators and Masks – 16 min. (Online @ CSU Learn)
- N95 Respirator Request Form (Online) – Attach a copy of the N95 online training “Certificate of Completion” when submitting the N95 Respirator Request form.
- Hot Work Permit (Weld./Cut./Hot Work App. 8.1)
Forms and Checklists
Supervisors Checklists
Instructors/ Students Checklists
Risk Management Forms
- Emergency Information Guidelines Form
- State Vehicle Driver Program Enrollment Form
- Authorization to Use Privately Owned Vehicles on State Business- Form STD 261
- Vehicle Accident Report Form for State Drivers
- CSULA Site Visit Checklist
- Individual General Release
- Class General Release
- Class General Release for Athletics
- Photo Release
- Photo Release (Spanish)