Permit Request • CampusOptics

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Basic Information

Brief description of context and setting of job. * Required

Author(s)* Required

Work Steps/Tasks: Include with each step the chemical hazards, physical hazards, risk level (no risk, minor, moderate, high), controls and safe work procedures.* Required

Resources

Particularly Hazardous Substances (PHS) used in the procedure and its PHS classification. Classifications include: carcinogen, reproductive, toxin, acute toxin.* Required

Personal protective equipment/Engineering controls needed* Required

Emergency Equipment Needed* Required

Waste Disposal

Waste Stream: include disposal plan and RCRA Hazard Classification(s) for each waste stream. * Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files