Business Services Form - Working in Isolation Checklist
This checklist is required to be filled out for any employee, student, or volunteer on campus that is performing a potentially dangerous task in an isolated environment under UWL's Working in Isolation Policy.
The Working in Isolation Checklist can be completed using the following form in DocuSign. Once you have filled out and signed the document. It will be sent to Business Services. A fully signed copy will be returned to the Supervisor for their records:
The Job Hazard Analysis document is a required attachment to the checklist. Click on the link below and download the document to your computer to start filling it out. A separate analysis needs to be completed and attached to the checklist for each unique task that the individual is performing.
Alternative Fillable PDF Form
If the DocuSign form cannot be used, the form can also be submitted as a fillable PDF: