INSTRUCTIONS: PROJECT REVIEW AND AUTHORIZATION FORM
INTRODUCTION: This review process is designed to insure that all CNSM faculty and staff projects/activities conducted outside of regularly scheduled classes and labs are safe and legal. Examples of such activities include Kaleidoscope, research projects, etc. The CNSM Constitution mandates that ALL SUCH PROJECTS/ACTIVITIES MUST BE EXAMINED AND APPROVED BY THE DEPARTMENT AND COLLEGE SAFETY COMMITTEE PRIOR TO THEIR UNDERTAKING.
**** FORM INSTRUCTIONS ****
1) APPLICANT: The applicant is considered the project supervisor and must be a University or Foundation employee. Projects conducted by others but under the auspices of the CNSM must be supervised by a CNSM employee. Adjunct professors and officially sponsored volunteer employees may apply. Student project authorizations are to be submitted by the supervising faculty or staff person. YOU MAY COMBINE RELATED PROJECTS AND THEIR PERSONNEL ON A SINGLE FORM.
NOTE: If you do not engage in or supervise non-classroom activities as part of your official job duties, this project authorization process DOES NOT APPLY to you. If not applicable, please simply complete section "1" of the form, mark "N/A" across the front and return it to your department EH&S committee chair. A written application form is required from each faculty member and technical staff.
2) LOCATIONS: Be as specific as possible. Include field sites associated with the project.
3) NAMES OF PROJECT WORKERS: This includes all persons involved with the project, including students. The first name on the form should be the alternate contact who is able to provide project information in the absence of the applicant.
4) PROJECT DETAILS:
(a) HAZARDOUS ACTIVITIES:
Chemical Hazards: List the types of the hazardous materials used the project, including significant amounts of hazardous consumer products (gasoline, coatings, adhesives, resins). Supply a SPECIFIC list of ALL EXTREMELY HAZARDOUS MATERIALS USED. The most common Extremely Hazardous materials are specifically listed in State regulations: Title 22 of the California Code of Regulations (22CCR), Section 66680, which is available from your department issue room or from CNSM Safety. All super toxic or water reactive chemicals are considered Extremely Hazardous and must be listed. Also declare use of all Cal/OSHA Regulated Carcinogens (CNSM Safety Program Manual, page 17).
Physical Hazards: List hazardous equipment/operations associated with the project: Motor vehicle travel, rock climbing, mine or cave entry, open flames, UV light, lasers, high voltages, microwaves, radiation, plasmas, cryogenics, high pressures, dangerous animals, power tools, etc. Biological Hazards: List any pathogenic organisms involved in the project. State if you intend to work with human tissues, blood or blood components.
(b) TRAINING PLAN: Describe methods used to ensure that project workers are aware of the specific nature of potentially hazardous equipment, practices and/or materials used in the project. Examples include mandatory participation in the CNSM New Employee Training Program, successful completion of prerequisite class/lab(s), required reading, exams, periodic safety meetings, distributing/maintaining a collection of Material Safety Data Sheets (MSDS's), etc. Training must address the hazards declared in section 4(c) above.
(c) SAFETY PROCEDURES AND/OR EQUIPMENT: Briefly describe safety procedures and equipment that will be employed to protect personnel from the hazards listed in part 4(a)&(b). If necessary, refer to the CNSM Safety Program Manual, "Green Sheet" Safety Memos for guidance in these areas. Required use of fume hoods, protective clothing, spill prevention/control equipment, fire extinguishers, radiation shielding, flame cabinets, etc. are examples of protective equipment. A mandatory buddy system policy and requiring drivers to obtain a CSULB Defensive Driver's Certificate are examples of safety procedures.
(d) SPECIFICALLY REGULATED ACTIVITIES: Circle the applicable activities that relate to the project. Feel free to write-in a regulated activity not furnished with the standard choices, such as use of DEA-regulated drugs.
5. KALEIDOSCOPE OR OTHER OUTREACH ACTIVITIES: Please submit a separate form for these activities.
ROUTING: Completed applications are to be reviewed by the department and college Safety Committees. Special conditions may be mandated. Originals go to the CNSM Safety Office, and copies to the department. rev. 9/96