Waiver Request Form Request Form

waiver request process discontinued as if summer 2010

Title is correct.  You are requesting a waiver request for; this is the waiver request form request form.  Before spending much time on this, READ CAREFULLY HERE:  Your Chemistry Dept supervisor must be willing to sign the waiver request form to say that you do not need to attend the 110-min "CHP2" training meeting.  Your professor might say that you should attend the CHP2 and forget the waiver business.  If you think your professor will sign the waiver request, continue.  Whether or not you are "excused from the CHP2 meeting, there are quite a number of important starting facts:

Every staff member engaged in laboratory work with chemicals must have Chemical Hygiene Plan training which conforms carefully to the requirements of the OSHA Laboratory Standard, and also must have PPE training that covers whatever personal protective equipment that they do or might need to use.

That training is the legal responsibility of the supervisor  --  the professor in the case of grad student and most other research staff -- and also the Department for which the staff member works.  Introductory Lab Safety Training for Lab Staff is offered by REM to help Departments and supervisors fulfill their responsibilities for staff training. 

 

It is not possible (or necessary) for REM to do every bit of this training for all workers for all of their work and time at Purdue.  It is not required that anyone take the REM training unless a Department or supervisor requires it.  Many Departments prefer to require some or all of the REM training.  But it is possible for the REM training to cover all of a worker's immediate chemical safety training requirements if the worker carefully follows the instructions for completing the training and information forms described here:

 

(1) online independent study in TWO parts; 
    (a) "CHP1" -- a fairly in-depth overview of the Chemical Hygiene Plan, and
    (b) "PPE" Personal Protective Equipment training,
          (If it has been more than 6 months since you completed the online exercises, do them again. If it has been <6 mo and you have lost the paperwork and forgotten, send email to request that this information be mailed to you. )

(2) a 110-minute small group training session (called "CHP2") which covers, for each worker, the very work area specific hazards of his/her job.  (for sign-up instructions go to REMCHP2training) 
       OR a waiver request from your supervisor indicating that the supervisor wishes that all of your basic safety training needs be taken care of by the supervisor and/or other group members.
 

You must have completed parts (1)(a) and (1)(b) above before continuing.

   

  
Do not complete this form for another person.  It is to be completed by the person for whom the waiver will be requested.
   Complete information is necessary.  

1. Enter date (mm-dd-yy) on which you last completed the CHP1 online reading exercise:  (Do not enter a date in the future.)    

2. Enter date (mm-dd-yy) on which you  last completed the PPE online reading exercise:  or enter NO PPE NEEDED.

3. Request

 

4. Your Name:

 

   

Exactly as it appears in the Purdue Electronic Directory e.g. Fatemeh Nasreen Olang, or Linda A Swihart

5. Campus Mail
Address: 

 

   

6. email address: 

   
@purdue.edu address if you have one, and please only if it works.  If you are so new that you don't have the @purdue address yet, we can work with what you have.

7. Department:

 

8. Staff type: 
undergrad student graduate student postdoctoral
Technical/service A/P Faculty
none of these    

9. Supervisor name: 

 
10.a
 In which building(s) will your work take place? 
 		 10b. Will you have any Purdue keys?
 yes       no       uncertain
 
 

   
Complete information is necessary

 
Check any and all chemicals, materials, items, procedures... likely to be included in your activities, even just a small percentage of the time. 

 

Yes

No

 

 

 

Yes

No

 

11.

 

Chemical hood ("fume" hood)

21.

 

Glassblowing

12.

 

biosafety cab or other laminar flow cabinet 

22. 

 

Carcinogens

13.

 

Rotary evaporation 

23.

 

Lasers

14.

 

Pressures below 20 torr 

24.

 

Toxic metals

15.

 

Pressures above 1.5 atm

25.

 

Pipetting

16.

 

Vertebrate animals

26.

 

Centrifugation

17.

 

Autoclave

27.

 

Cryogen(s)

18.

 

Halogenated solvents 

28.

 

Voltages greater than 220V

19.

 

Radioisotopes

29.

 

Human cells, fluids, or tissue

20.

 

X-ray or higher energy 

30.

 

Other biological agents

Provide chemical names or other complete descriptions of any of the following you will work with (separate with commas).  Write NONE where it is the correct response. Use no carriage returns (line breaks).

31. compressed gases

 

32. halogenated solvents

 

33. flammable liquids

 

34. other toxic materials

 

 

List the most important, most hazardous, most frequent, largest quantity.... hazardous chemicals with which you do work or will work.   Enter all you can think of, up to ten.  Two are required.  (In the fields numbered 35 and 36.)  

  

35.  

 40.

36.  

 41.

37.

42.

38.

43.

39.

44.

  

45.  Describe your work or anticipated work with chemicals and equipment somewhat completely and carefully, in such a way as to give a clear impression of it to an intelligent person with a strong science background who does NOT have experience in you field of study.    Use sentences or phrases separated by periods, *not* line breaks.  Also enter any comments, concerns or questions you have:

 

 
submit button removed and waiver request process discontinued as if summer 2010  

IF A "FRONT PAGE ERROR" or a "SERVER ERROR" occurs, write swihart@purdue.edu immediately please.

 
Comments to: swihart@purdue.edu
last review or update April 30, 2010