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WVU Environmental Health & Safety Service Request Form

Complete this form to request assistance from West Virginia University's (WVU) Environmental Health and Safety (EHS) office regarding environmental, safety and health concerns and hazards. If imminent danger is present or immediate response is needed, please contact EHS directly at (304)293-3792. To report an incident, please complete the Injury/ Illness Report Form found at http://ehs.wvu.edu.

Note: If you have a Hazardous Waste Request, please complete the Hazardous Waste Disposal Form located on our website.

Please provide the following contact information:

Date of Request (MM/DD/YYYY)

Name (First, Last)

Department

Email

Phone Number

Supervisor Name

Supervisor Phone Number

Is this a request for the WVU Health Sciences Center?

Yes
No

If you are a WVU employee, have you reported this to your Supervisor?

Yes
No

Service Requirement

Location/ department of the needed request

Description/ reason for needed request:

Lab Safety Service Request

Industrial Hygiene Service Request

Risk Assessment

Overall Job Hazard Assessment
Equipment Hazard Assessment

Safety Service Request

Training Service Request

Environmental/ Public Health Service Request

Hazardous Materials Service Request

Preferred Service Time:

THANK YOU: Your request will be addressed by an Environmental Health and Safety representative within a 24 - 48 hour period. For immediate response, please contact WVU EHS at (304)293-3792 or visit EHS's website at http://ehs.wvu.edu/.