University of California, Berkeley
Injury and Illness Prevention Program (IIPP) Template and Forms
|Number||Title||Word file||PDF file|
|IIPP Template (does not include forms)||Word|
|Form 1||Report of Unsafe Condition or Hazard||Word|
|Form 2||Safety Committee Meeting Documentation||Word|
|Form 3-Lab||Laboratory Safety Self-Assessment||Word|
|Form 3-Gen'l||General Safety Self-Assessment||Word|
|Form 3-Office||Office Safety Self-Assessment||Word|
|Form 3-Shop||Shop Safety Self-Assessment||Word|
|Form 3-Storage||Storage Space Safety Self-Assessment||Word|
|For DSCs Only||2012 Laboratory and Shop Safety Self-Assessment Program Summary Form||Word|
|Form 4||Hazard Correction Report||Word|
|Form 5||Occupational Accident , Injury or Illness Investigation Report||Word|
|Form 6||Safety Training Attendance Record||Word|
|Form 7||New Employee Safety Training Record||Word|
To use the IIPP Template
To use the Forms
There are three ways to view and use the forms:
1) Word File - Download a Word file if you want to have the form on your computer. With a Word file you are able to open the file and add or change the content before printing it out.
2) PDF - Download a PDF (Portable Document Format) file if you want a formatted document that you can print out to your local printer. With a PDF file you will not be able to make changes to the document.
3) View Online - Click on link to view document on the web.
Injury and Illness Prevention Program (IIPP) - Provides program overview, resources and assistance.
The documents you will be downloading were created in Microsoft Word. They can be downloaded by Macintoshes, PCs, and Unix systems. Downloading them will be easiest if your browser's preferences for helper applications are properly set. You can set helper application preferences to launch your word processing application upon receiving the documents or to save them to any location you choose.
If your downloading results in a plain document icon, start your word processing application, then use its "Open" command to open the file. Macintosh users should note that the IIPP file is too big to open through Simple Text.