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Forms for safety and health

Most of the forms below are PDF files. If you encounter any problems viewing PDFs on your computer, you may need to install the free Adobe Reader software.

PLEASE NOTE: The “Application For Age 26 Young Adult Coverage” form is no longer required by the UFT Welfare Fund. Members wishing to add a dependent under age 26 to their Welfare Fund coverage at no cost should use the Welfare Fund’s online Update Your Information (Change of Status) form.

Use the forms in this package to report occupational exposure incidents. Exposure incident means a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties. Parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.

Form and instructions from the DOE Science Safety Manual.

This form for Lab Specialists is taken from the DOE Science Safety Manual.

If there is equipment in your school that is unrepairable, not cost-effective to repair, educationally inappropriate, or a safety hazard, complete this form to have the equipment removed.

Guidelines for school staff and students who are involved in making the classroom and the laboratory safe places to work. 2008 edition.

To provide instructions and minimize risk to members of the service (uniformed and civilian) or auxiliary police officers who have contact with or handle an animal or person who may have an infectious disease, or who have contact with or handle hazardous materials.

Especially for Lab Specialists. Use Page 1 to document the presence of mercury in a science room.

Members of the service are reminded that basic infection prevention precautions should always be utilized when coming in contact with any individual to guard against common infections, as well as emerging infections, such as novel coronavirus (ncov).

Use this form to document a hazardous chemical exposure incident in your school. Parts I, II, and III of the form are included.

The purpose of this guidance is to explain the relationship between the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, and to address apparent confusion on the part of school administrators, health care professionals, and others as to how these two laws apply to records maintained on students.