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Forms & templates

This page collects together the current versions of all forms and checklists available from Health & Safety Services. Please select from the topic list below.

Display Screen Equipment (DSE)
DSE workstation checklist [SG13 Appendix 3] DSE workstation checklist
Eyesight test request form Eyesight test request form
 PhD student checklist Ph.D student checklist

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Driving
Driver record form Driver record form 
Vehicle safety checklist Vehicle safety checklist
Generic driving risk assessment Generic driver risk assessment

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Events
Event notification form

Event Notification Online Booking Form

An example of a completed form can be found in Event Management CoP 33

Event risk assessment Event Risk Assessment
Event risk assessment example Event Risk Assessment Example
Event contractor competency questionnaire Contractor competency questionnaire
E&F form - safety check of temporary electrical installation Safety check of temporary electrical installation
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Maternity Risk Assessment

MRA1 New & Expectant Mothers Risk Assessment

CoP 57 Maternity  

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 First Aid
 Appointed Person Template Letter

Appointed Person Template Letter

 First Aid Needs Assessment First Aid Needs Assessment Form 
 First Aid Poster First Aiders Poster Template

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Fire safety
University fire procedure poster Fire procedures poster
Personal Emergency Evacuation Plan Personal Emergency Evacuation Plan
General Emergency Evacuation Plan General Emergency Evacuation Plan

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Genetic modification, radiation & biological safety
GM Workers Registration Form See Genetic Modification
GM Project Application Form - low risk See Genetic Modification
GM Project Application Form - standard See Genetic Modification
GM Risk Assessment Form GM03 See Genetic Modification
Biohazard Risk Assessment Form See Biological Safety
Occupational Health Questionnaire for Work with Genetically Modified Organisms and Hazardous Biological Agents.
Activity-specific radiation risk assessment for and local rules for a controlled area See Radiation Safety Secure Area
Example of a completed activity-specific radiation risk assessment for and local rules for a controlled area See Radiation Safety Secure Area

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H&S induction
Induction checklist for new staff and postgraduate students Health and Safety Induction Checklist
Health & Safety Information for Staff leaflet Health and safety information for University staff

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H&S inspections
Inspection checklist for offices and general work areas General office workplace inspection checklist March 2009

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Incident reporting & investigation
University incident report form for reporting significant incidents and near misses to Health & Safety Services (if unable to access the online form) University incident report form
Accident / incident investigation checklist Investigation checklist
Incident investigation report template Incident investigation form

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Laser safety
Laser Registration Form and guidance notes - for use when registering a laser facility with Health and Safety Services Laser registration form and guidance notes
Laser Risk Assessment Form RA2L Laser risk assessment form RA2L

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Local H&S Code   
Local H&S Code Local H&S Code template

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Manual handling
Manual Handling Risk Assessment Form (MH2) - specific assessment MH risk assessment form MH2

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Risk assessment - general
Generic Risk Assessment Form (RA1) Risk Assessment Form RA1
Project / Task Assessment Form (RA2) - to be used for assessing specific and more hazardous tasks UoR Project risk assessment form RA2
Risk Assessment Log - to be used to list all risk assessments for an area

Risk Assessment Log

Travel Risk Assessment - overseas TRA1 - International Travel Risk Assessment
Travel Risk Assessment TRA2 Off Campus UK Business Travel Risk Assessment Non-fieldwork

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Other Resources
Template for Health and Safety Code - to be used by Schools/Functions

Local H&S code template

Template for Annual Performance Review - to be used to assist Schools/Functions check that their H&S management system is working effectively and addresses all significant risks To be added
Permit required for all maintenance, servicing and non-routine cleaning work in the University laboratories and workshops. Permit to Work - Labs & Workshops
Laboratory decommissioning and clearance form Laboratory decommissioning and clearance form
Radiological decommissioning and clearance form Radiological decommissioning and clearance form
Sample training matrix

Sample training matrix

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PPE
Respiratory Protection Equipment (RPE)  Qualitative face-fit testing report form
Respiratory Protection Equipment (RPE)   RPE maintenance record form
Reusable hearing protection maintenance record form  Reusable hearing protection maintenance record form

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Things to do now

Contact Health & Safety Services: