Employee* Safety Training Assessment

In collaboration with your supervisor, referencing your work spaces' Workplace Hazard Assessment (WHA), please be sure assess your safety training needs any time your duties change, whether you've been a UConn Husky for 30 years or 30 seconds.

Be sure to connect with EHS staff if you have questions about follow-up or recurring training requirements relevant to your position. We're here to help. If you are a new member of the community, welcome to the University of Connecticut.

*This form should be completed by all new faculty/staff/student employees in their first week of any new University of Connecticut position, prior to starting any potentially hazardous job duties. This form should also be completed by any undergraduate students involved in non-course research or creative activity in potentially hazardous environments (e.g., lab, shop, studio, farm).

Employee/Researcher Name*
Prefix First Last
University Email Address*
If you are a contractor or visiting researcher without a UConn email address please indicate the email address you use for correspondence with UConn.
Enter Email Confirm Email
Supervisor/PI Name*
Prefix First Last
University of Connecticut Supervisor/PI Email*
This will automatically generate a confirmation that goes to your PI/Supervisor. Note: If you are a faculty member leading your own research program you may list yourself.
Enter Email Confirm Email
Start Date*
Please list the date you will begin your new duties.
MM slash DD slash YYYY
General Workplace Hazard Assessment**
Please select the choice below that best describes the work you will do in your new position at the University of Connecticut. Pick one. If you have two or more roles, complete one ESTA for each role. Based on your choice, you and your PI/supervisor will be directed to take the appropriate next steps to ensure you are in compliance with safety training related to your duties. Please expect an email with directions after you submit your ESTA.
- I will work in a research lab with or around potential hazards.
- I will work in a shop/studio/farm/or facilities location with or around potential hazards.
- I will work in a standard office environment with no potentially hazardous duties.
- I will work from my home office.
*Hazards may include biological, chemical, radiological, or physical. Typical examples include job duties requiring the use of cleaning or lab chemicals, working from heights, using power tools and equipment, or caring for animals.
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Name
This field is for validation purposes and should be left unchanged.

Environmental Health and Safety

ESTA

Employee* Safety Training Assessment

Please complete the ESTA from below: