Forms
Mobile Elevated Work Platform
- Mobile Elevated Work Platform Pre-Start Inspection Checklist
- Mobile Elevated Work Platform Occupant Training Checklist
- Mobile Elevated Work Platform Exit Permit
- Mobile Elevated Work Platform Daily JHA & Rescue Plan
Emergency Procedures
Administered by UVA Emergency Management
Contractor Safety Acknowledgement
Fall Protection
Inspections
Correct inspection procedures can prevent incidents, injury/illness, and/or property/equipment damage.
Job Hazard Analysis
Permits
Permits are an essential tool for assuring safety during potentially hazardous work activities. The process guides the supervisor and employees through a systematic evaluation of the task to be completed.
Respirator Forms
If you have questions about your respirator or would like to request sampling or training, email [email protected].
Learn how to don (put on) and doff (take off) an N95 respirator.
- Medical Evaluation Questionnaire
- KN95 Respirator Voluntary Use Form
- Non-Routine Respirator Use Plan
- OSHA Respirator Medical Evaluation Questionnaire
- Respirator Fit Test and Training
- Respiratory Protection Program Exit Form
- Respirator Use Information
- Respirator Voluntary Use Form
- Worksite-Specific Procedure for Voluntary Use of Filtering Facepiece Respirator
- Worksite-Specific Procedure for Use of Respiratory Protection
Safety Shoe Request
- Safety Shoe Feedback Form
- Safety Shoe Request Form
- Safety Shoe Program
- Personal Protective Equipment (PPE) FAQs
Sampling
Sampling and analysis is conducted on jobsites and at regular work tasks by an occupational health and safety professional to look for physical stressors, biological hazards and chemicals to ensure workplace safety. Email [email protected] if you have questions about this process.
Training
Worker's Comp, Incident, and Near Miss
- Near Miss Report Form – Only use this form for incidents that did not result in injury. A near miss event is defined as an unintentional in nature, unsafe occurrence that could have resulted in an injury or fatality. Only a fortunate break in the chain of events prevented an injury, fatality, or damage.
- Workers’ Compensation/Accident-Injury Reporting Portal. Please note that as of July 1, the UVA FM safety incident reporting system is now housed in your UVA Workday account. Login with Netbadge to start your report. In the Workday mobile app, type “Safety Incident Report” in the search bar to begin.