Environmental Health and Safety Mandatory Training

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Environmental Health and Safety Mandatory Training

Please select all of the applicable training sessions listed below. For on-line guidance on completing this form, please visit the EHS website. For questions about completing this form, call Environmental Health and Safety at (305) 243-3400.

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Employee Name (Type in a response)
 
 
UM ID Number (Type in a response)
 
 
E-mail Address (Type in a response)
 
 
* Position Title (You must type in a response)
 
 
PAS-34 Number (Type in a response)
 
 
* Position Number (You must type in a response)
 
 
Hire/Transfer/Promotion Date (Type in a response)
  mm/dd/yyyy
 
 
* Department Name (You must type in a response)
 
 
* Supervisor's Name (You must type in a response)
 
 
* Account Number (You must type in a response)
  For EHS employee health charges. You will be notified before any charges are submitted.
 
 
* Campus (Select only one)
 
 
Training Required Annually (Select at least one)
 
Biomedical Waste: Will the employee be required or expected to handle biomedical or infectious waste?
Bloodborne Pathogens: Will the employee be potentially exposed to human blood, body fluids or unfixed tissue?
Hazardous Waste: Will the employee handle chemicals and generate hazardous (chemical) waste? This includes most laboratory workers.
Hazardous Waste Operations: Will the employee process hazardous (chemical) waste or be required to respond to emergencies involving chemicals? This does not include employees who generate hazardous waste, e.g., laboratory workers.
Lead: Will the employee be working in an environment or under conditions which could result in exposure to lead? This includes metallic lead, all inorganic lead compounds and inorganic lead soaps.
Occupational Noise: Will employee be working in an environment or under conditions that have been determined to require the implementation of a hearing conservation program and issuance of hearing protection? (Where it has been determined that employees are exposed to an 8-hour time-weighted noise exposure of 85dBA or impact noise of 140dB.)
Powered Industrial Trucks: Will the employee be required to operate a powered industrial truck, suck as a forklift?
Respiratory Protection: Will the employee be required or expected to wear a respirator?
Spill Prevention, Control and Countermeasures (SPCC) Plans: Will the employee be required to inspect and maintain fuel storage tanks or other oil storage areas?
Tuberculosis (TB): Will the employee work on the Medical Campus or will the employee routinely work in areas where patients are seen?
None of the training above applies to this position or employee.
 
Training Required Biennually(every two years) (Select at least one)
 
Shipping Hazardous Materials (Chemicals): Will the employee be expected or required to ship chemicals?
Shipping Infectious Substances: Will the employee be expected or required to ship infectious or potentially infectious substances or diagnostic specimens?
None of the training above applies to this position or employee.
 
Training Required Triennually(every three years) (Select at least one)
 
Occupational Health Program: Will the employee have contact with research animals?
None of the training above applies to this position or employee.
 
Training Required Only Once (Select at least one)
 
Electrical Safety: Will the employee be required or expected to work in an environment where there is a risk of electric shock resulting from contact with electrical current? Use of consumer electronic devices does not require training.
Fire Safety: Will the employee be required or expected to use a fire extinguisher in the event of a fire?
Hazard Communication: Will the employee use hazardous chemicals at work or work in an environment where hazardous chemicals are used or stored?
Laboratory Safety: Will the employee be engaged in the use of hazardous chemicals or infectious agents in a laboratory?
Laser Safety: Will the employee work with laser-emitting equipment or in an environment where laser-emitting equipment is used?
Latex Allergy: Will the employee be required or expected to use items made with latex rubber?
Lock Out/Tag Out: Will the employee be required or expected to perform servicing or maintenance on a machine or equipment where the unexpected energizing, startup, or release of stored energy could occur and cause injury?
Permit-Required Confined Spaces: Will the employee be required or expected to enter a permit-required confined space? (A permit-required confined space means a confined space with one or more of the following characteristics: 1) is not intended for human occupancy 2) contains or has a potential to contain a hazardous atmosphere; 3) contains a material with potential for engulfing an entrant; 4) has an internal configuration such that an entrant could be trapped or asphyxiated by inwardly converging walls or by a floor which slopes downward and tapers to a smaller cross-section; or 5) contains any other recognized serious safety or health hazard.)
Personal Protective Equipment: Will the employee be required or expected to use or wear equipment to protect the head, face, eyes, hands or feet from injury?
None of the training above applies to this position or employee.