Permit Request • CampusOptics

This self audit can assist you with safety compliance and helps EH&S provide additional services where needed. Due to the processing of these requests, please fill in the date and time WITH TOMORROWS DATE. Under location, please select your building and provide your room number(s) in the Additional Location Details field.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date

Expiration Time

Location

Name* Required

Additional Location Details

Inspection Information

Building and Room Number of Mechanical Room * Required

Department Responsible for Mechanical Room * Required

Housekeeping

The following are true of the working area

All work areas are clear of clutter
All floors and aisles are clear with no slips, trips, and fall hazards present

The following facilities are in working order

All ceiling tiles are in place and in good condition
Trash is being disposed of properly
All lights are in working order
All pipes are insulated

Compressed Gas Cylinder

The following safe compressed gas practices are being used

Cylinders do not appear to be damaged
Cylinders are secured
Cylinders are marked with hangtags indicating: Full, In Use, or Empty
All cylinders are equipped with a regulator or cap
All cylinders are labeled
Cylinders are segregated by hazard class
Cylinders are stored away from heat and electrical sources
All connections are in good condition, free from cracks, holes, and other damage

Electrical Safety

The following electrical hazards are being mitigated

Access to the electrical panels is clear (3 feet of clearance)
The electrical panel door fully closes
Extension cords are not being used permanently
Power strips are being used correctly (not overloaded, no extension cords or additional power strips plugged into them)
Power strip cords are intact and in good condition, free from damage and deterioration
Emergency power outlets are marked and used correctly
Cords are out of the way and not creating a trip hazard
All electrical, including light fixtures, are protected
Cover plates are in place on junction boxes to eliminate exposed wiring

Exits and Corridors

All corridors and exits are free from obstructions

Exit signs are posted and properly illuminated to clearly indicate exits

Fire Protection

The following fire hazards are being mitigated

There is clearance of at least 18 inches maintained around fire sprinkler heads and 2 feet below the ceiling height
Combustibles are not stored in excess amounts (cardboard, paper, wooden crates, etc.)
Fire doors are closed when not in use
Walls and floor are free of holes/cracks/ and other penetrations
Fire extinguishers and signs are clearly visible
Fire extinguishers access is clear and unobstructed

Ladder Safety

The following safe ladder practices are being used

Portable ladders are in good condition and safe to use
Fixed ladders are in good condition and safe to use

Railing/ Guarding

Are drain openings, pits in the floor, or walking surfaces guarded?

Are machine moving parts properly guarded to protect workers?

Storage

The following safe storage practices are being used

Items are stored in a stable location to prevent tipping/falling
Product and chemical containers are properly labeled

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files