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Office of the University Attorney
Appalachian State University
ASU Box 32126
Boone, NC 28608
828-262-2751
© 2008 Appalachian
State University
Website maintained by Kathy Deas |
Safety and Workers' Compensation
Appendices and Forms
Appendix 1 - Employer's Report of Injury to Employee
A copy of I.C. Form 19 can be obtained from the University's Electronic Forms Web Site .
Appendix 2 - Emergency Telephone Numbers
Appalachian State University
Emergency Numbers
Listed in Priority Order
| NUMBER |
AGENCY |
| 9-911 |
FIRE DEPARTMENT
AMBULANCE
BOONE POLICE |
8000 (EMERGENCY)
2150 (NON-EMERGENCY)
|
UNIVERSITY POLICE |
| 262-4007 |
SAFETY & WORKERS' COMPENSATION OFFICE |
| 262-3100 |
STUDENT HEALTH SERVICES |
| 262-4100 |
WATAUGA MEDICAL CENTER |
| 264-4235 |
WATAUGA CO. EMERGENCY
MANAGEMENT COORDINATOR
(Local Emergency Operations Center) |
| 800-846-6946 (EMERGENCY) |
POISON CONTROL:
CAROLINA MEDICAL CENTER,
CHARLOTTE, NC |
Appendix 3 - Supervisor's Accident Report Form
A copy of the Supervisor's Accident Report Form can be obtained from the University's Electronic Forms Web Site .
Appendix 4 - Accident Report Form
A copy of the Accident Report Form can be obtained from the University's Electronic Forms Web Site.
Appendix 5 - Fire and Safety Exit Drill Report
A copy of the Fire and Safety Exit Drill Report can be obtained from the University's Electronic Forms Web Site.
Appendix 6 - Industrial Hygiene Assistance Request Form
A copy of the Industrial Hygiene Assistance Request Form can be obtained from the University's Electronic Forms Web Site .
Appendix 7 - Application for Use of Open Flame Devices
Click on link
Application for Use of Open Flame Devices
Appendix 8 - Notice to Remove Open Flame Device
Click on link
Notice to Remove Open Flame Device
Appendix 9 - 2nd Notice to Remove Open Flame Device
Click on link
2nd Notice to Remove Open Flame Device
Appendix 10 - A.R. Smith Department of Chemistry Appendix to the Chemical Hygiene Plan
| 1. |
Every employee shall follow the current safety rules for the A. R. Smith Department of Chemistry. |
| 2. |
Every employee shall be provided with the most current edition of the American Chemical Society publications 1 , 2 , “Safety in Academic Chemistry Laboratories,” Volumes 1 & 2. Guidance for specific chemicals and operations is provided in these publications. It is the employee's responsibility to become familiar with information relevant to their lab operations in these publications. |
| 3. |
Every employee shall receive training as required in the most current edition of the University Chemical Hygiene Plan. The training procedure is outlined in the A.R. Smith Department of Chemistry Chemical Hygiene Training Checklist. |
1. American Chemical Society Joint Board–Council Committee on Chemical Safety. Safety in Academic Chemistry Laboratories: Accident Prevention for College and University Students , 7th ed.; American Chemical Society: Washington, DC , 2003.
2 . American Chemical Society Joint Board–Council Committee on Chemical Safety. Safety in Academic Chemistry Laboratories: Accident Prevention for Faculty and Administrators , 7th ed.; American Chemical Society: Washington, DC , 2003.
Revised 11/4/2004
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