Washington State University
SAFETY POLICIES AND PROCEDURES MANUAL

INTRODUCTION / ORGANIZATION
1.20
Revised 9-14
Procedures, Records, and Forms
335-2005

SPPM Forms Index

PDF link


Forms may be available in the following formats:


Title/Number/
Last Revised
Primary Purpose Where Available

SPPM Reference

Chemical Collection Request/
WSU 1280/ 10-94
For proper disposal or recycling of chemical substances. Paper: US Item #47860,
Environmental Health and Safety's Environmental Services web site

5.66

Fall Protection Work Plan/ 10-92 To document actions taken to prevent falls. Required when working ten feet or more above the level below. PDF: 3.34.6-7

3.34

Full-Size Van Driver Safe Driving Practices Acknowledgment Statement/
WSU1426/ 7-09
To record driver acknowledgment of risks an recommended safe driving practices for operating a full-size van. PDF 7.10.22

7.10

Full-Size Van Driver Valid License to Drive and Driving Experience Statement/
WSU1427/ 7-09
To record manager/supervisor and full-size van driver acknowledgment of responsibilities prior to and during the driver's assignment to operate a full-size van. PDF 7.10.23

7.10

Hazard Notification/
WSU 1247/ 1-09
To report safety hazards or unsafe practices. PDF: 2.52.2

2.52

Incident Report/
WSU1131/ 1-08
To report accidental injury or work-related illness involving WSU employee or third party; may also be used for property damage. Online: Human Resource Services website

2.24

Material Safety Data Sheet (MSDS) Request/
WSU 1391/ 4-09
To request an MSDS for each hazardous chemical in the workplace. PDF: 5.10.5

5.10

Public-Access Defibrillator Use Agreement/
WSU1477/ 12-09
To request approval to install and use an automated external defibrillator (AED) in a University location. PDF: 2.46.3

2.46

Respirator Authorization/Respirator Fit-Testing and Training Record/ 2-00 To authorize the use of respirators and provide a record of respirator fit-testing and respirator use training. Paper: Environmental Health and Safety

3.24

Safety Inspection Checklist/
WSU 1250/ 10-07
To conduct self inspection of department/ work area and document findings and corrective actions. PDF: 2.50.3-12

2.50

Safety Meeting Report and Agenda/
WSU 1248/ 10-11
To document safety committee or foreman- crew meetings. PDF: 2.12.4-5

2.12

Safety Orientation Checklist/
WSU 1249/ 1-13
To document review of safety procedures. PDF: 2.16.2

2.16

Supervisor's Accident Investigation Report/
WSU 1246/ 8-97
To document an accident investigation. PDF: 2.26.5

2.26

Witness or Injured Person Statement/
WSU 1315/ 9-13
To record a description of an accident. PDF: 2.26.6

2.26