Safety Forms

Name

Short Description

Incident Reporting Form UBC’s Centralised Accident/Incident Reporting System (CAIRS) for all Faculty, Staff, Students, and Visitors.
Emergency Contact Information

To be posted on equipment in your lab.

Includes: experiment name, emergency shut down procedure, list of hazardous materials, contact information, etc.

CHBE Training Record Form Used to document safety-related training (e.g. safety orientation, equipment-specific procedures, chemical-specific procedure, etc.)
Research Clearance Form
  1. Graduate students submit this form with their thesis or report. Others submit this form prior to leaving the department.
  1. Contact the CHBE Safety Program Officer, Miles Garcia (604 822-3857, miles.garcia@ubc.ca) to make an appointment to check-out and walk through the lab clearance.
  1. After consultation with your advisor, determine disposition of equipment and chemicals/samples. Complete de-commissioning checklist for all equipment to dismantle. List all equipment you have used throughout your research on the attached list (page 3) and all chemicals you will be leaving behind (page 4).

Please ensure your office, desk and designated filing cabinets are CLEANED OUT prior to your departure.

General Inspection Checklist A general safety inspection checklist by UBC Risk Management Services suitable for offices, classrooms, etc.
Laboratory Inspection Checklist

A checklist by UBC Risk Management Services for a more comprehensive laboratory inspection.

 

Safety Audit/Inspection Follow-Up Form

To be used for following up on safety issues discovered during a lab inspection/audit and the corresponding corrective actions assigned.

Satisfactory completion of this form is required before proceeding with an experiment in the case of a safety audit.

UBC Workplace Safety Orientation Form To be used by ALL new CHBE employees (including Faculty, Staff, Paid Students, etc.) during their orientation process and signed by their supervisor(s). UBC Risk Management Services has developed Safety Orientation Guidelines that include a template Safety Training Record and a Personal Safety Checklist template for new workers to complete as part of their orientation.
Building Perimeter Inspection Checklist This inspection form by UBC Risk Management Services is intended to provide UBC- Vancouver Campus Faculty and staff with an overview of the level of personal safety inside and outside of their buildings of responsibility. Corrective actions that are unable to be resolved by either UBC Building Operations (604-822-2173) and/or the LHSC should be forwarded to Campus Security (604-822-2222) for review.
Laboratory Equipment Safety Inspection Checklist

To be completed for all equipment before the first use of the equipment (and annually thereafter) and after any modifications (to the equipment, environment, work process, etc.).

Includes specific hazard information, spill control measures, safety features, past safety problems, etc.

Simplified HAZOP Worksheet

Hazard and Operability Study (HAZOP) form to identify and plan for different problems that may arise during an experiment and the mitigating requirements.

To be completed and submitted for each experiment as part of the Safety Audit.

Preliminary Hazard Analysis Checklist

Basic checklist for initial planning of experimental set-up safety.

To be completed and submitted for each experiment as part of the Safety Audit.

Shop Inspection Checklist

Checklist for inspecting the CHBE Work Shop.

To be completed by the CHBE Work Shop Safety Rep monthly.

Office Area Inspection Checklist

Checklist for inspecting the CHBE Office Area.

To be completed semi-annually (every June, January).

Monthly Laboratory Safety Checklist To be completed for every lab by the Lab Safety Rep(s) monthly (due every 15th of the month).
Empty Chemical Labels Bar codes are removed from chemical containers and placed on this form. The bar codes can then be scanned out of the chemical inventory.

Undergrad Team Safety Package

(Word / Google Drive)

Undergraduate group projects using the Department may require the use of potentially dangerous equipment, materials and chemicals. Undergraduate students must complete the safety approval process to review the hazards of the project and how they will accommodate these hazards while maintaining a safe work environment in the laboratory.