Forms and Templates
UA and UAA Authorized Forms and Templates
The following is a collection of approved forms and templates to be used for the designated purposes:
Below is a list of forms and some information sources for Claims Management in the UA system. If you have come here to fill out a form for an incident or injury, please remember to notify Environmental Health and Safety in addition to any other entity you may be notifying. If you have any questions regarding the application, purpose, or process of completion of these forms or the notification process, please contact Environmental Health & Safety.
The following are some forms and templates for Environmental Health & Safety purposes. By no means is this list comprehensive. If the information you are looking for is not listed here, please feel free to contact EHS for further information.
- AED Post Incident Report
- Physical Agent Data Sheets (PADS)
- Bloodborne Pathogens Exposure Control Plan Template
- UAA Chemical Hygiene Plan (CHP)
- Municipality of Anchorage Assembly Permit (Fire Permit)
- HBV Vaccination Waiver Form
- OSHA Required Medical Examinations/Procedures
- Needlestick Report Form
- Hazard Assessment Certification Form
Below is a list of forms and a few resources for information on insurance and risk in University of Alaska system. In addition, there is also a list of the "Red Flags" for Risk Management. If you are coordinating an event, function, or program that will utilize one of the below forms or involves activities listed in the "Red Flags" list, please contact Environmental Health and Safety. Proper precautions and documentation must be accomplished before activities of this sort are undertaken and EHSRMS would be happy to assist in acomplishing these tasks.
- Transportation of people using non-common carriers, (includes personal vehicles), to transport students, guests, and visitors.
- Involvement of minors (under the age of 18) in any university program or activity. See program evaluation and planning tools at: Minors in UA Programs & Events
- Use of hazardous chemicals or materials in any program or activity.
- Performing hazardous activities (extreme sports, wilderness events, ice or mountain climbing, bonfires, use or carrying of firearms, etc.).
- Contracts and memoranda of agreements with outside entities that include insurance or indemnification clauses that have not been approved by General Counsel and/or Risk Services.
- Foreign travel by employees and students (includes Mexico and Canada).
- Paying student salaries through the university system to work for other entities.
- Renting vehicles for use by non-employees.
- Art Exhibit Record
- Board of Regents Designation of Beneficiary
- Agreement for use of UA Equipment or Vehicles. There are two forms. The Statewide form with legal language exists to document the acceptance of liability by the user. The other Statewide form is used to track the location of equipment of over $5000 dollars worth. Both forms should be filled out for any personal use of equipment (second form used if worth is over $5k) and kept by department. The $5k form should be forwarded to Procurement as well.
- UA Special Event Insurance for Use of UA Facilities Only
- Facilities/Premises Use Agreement
- Foreign Visitor Travel Brochure and Application
- Loss Prevention Program
- Alaska Limited Governmental Notary Commission Application
- Sports Camp Insurance
- Student Accident Insurance Application, Brochure, and Election/Rejection Form
- Student Professional Liability Insurance Application
- Auto Insurance Card
- UA Contracting Information and Templates
- UA FERPA Clause for Agreements Involving Students
Below is a list of forms utilzed for release of liability. If you have any questions regarding the application, purpose, or process of completion of these forms, please contact Environmental Health & Safety.
- Detailed Assessment Form - White Paper
- Rapid Assessement Form - White Paper
- Fixed Equipment & Nonstructural Checklist - White Paper
- Inspected (Occupancy Permitted) Placard - Astrobright Gemini Green Paper
- Restricted Use Placard - Astrobright Solar Yellow Paper
- Unsafe Placard - Astrobright Rocket Red Paper
Below is a list of forms utilized for Laboratory purposes. If you have any questions regarding the application, purpose, or process of completion of these forms, please contact Environmental Health & Safety.