Submission Form: EHS: Indiana University

Hazard Assessment Request

EHS can conduct comprehensive hazard assessments to determine what hazards are present and provide recommendations for engineering controls, personal protective equipment, or safe work practices to effectively reduce or eliminate risks. Please complete the information below and submit to request an assessment.

Please list any chemicals or products that you use in your job tasks:

Please list any equipment that you use in your job tasks:

Please list any areas where you perform job tasks in addition to your main work area:

Please describe any specific concerns that you have:

Name:
Lab Group or Department:
Building and Room:
Job title (or student):
E-Mail Address:
Phone Number:

OFFICE OF ENVIRONMENTAL, HEALTH, AND SAFETY MANAGEMENT

Hazard Assessment Request