TITLE:	ES&H Manual
DOCUMENT ID:	5400 Appendix T2 Forms and Schedules

This appendix contains certain forms and content listings to assist files custodians in managing Environmental, Safety, Health, and Quality (ESH&Q)-related records. Refer to the Jefferson Lab Records Management Handbook for assistance in knowing how, what, and when to use these forms.

Many activities previously completed with paper forms can now take place using online submission and request forms at http://www.jlab.org/div_dept/cio/IR/records/index.html.

ES&H Manual Chapter 5400 Appendix T1 Summary of ES&H Documentation Requirements contains information regarding most of the ESH&Q-related regulatory and contractual documentation and recordkeeping requirements at Jefferson Lab.

· Figure 1: Records Inventory and Disposition Schedule (RIDS)

This is the Department of Energy (DOE) form 1324.10 (a sample form follows) that is used to maintain the records inventory and identify disposition authority of all records maintained by a files custodian. In general, this form is used when a record file system is initially established. This is accomplished by the files custodian in coordination with the Jefferson Lab Records Manager.

The RIDS should be used to maintain information of all ESH&Q-related records for which you are responsible, including records in storage. The information contained on this form is a summary of existing files, and how and when they can be appropriately disposed of. Using this form simplifies the review process when it comes time to dispose of old records.

o An example -Environment Management Files. The disposition authority is DOE Records Schedule (DOERS) which determines the authorized disposition of the record. The disposition authority is cited at DOERS 1.(2) for these particular records, which states to destroy when 15 years old.

· Figure 2: Records Disposition and Retrieval Request (RDR) Form

This form is used for all document transactions between a files custodian and the Records Manager.

This form must be submitted to the Records Manager whenever a files custodian wishes to place or retrieve a file from the records storage room. Using this form will help to track all record transactions, ensuring that documents do not become misplaced.

o An example -Radiation Control Exposure Records. Since these files must be kept for an extended period of time (75 years), it may be beneficial to transfer these files to the records storage room. Complete the RDR and submit it, along with the files to be stored, to the Records Manager.

• Figure 3: Records Log Form

This form is used by the divisions/departments to maintain a record of the storage and disposition of records, including ESH&Q-related information. This form should be used when maintaining internal records within the office, as well as to keep track of records that have been sent to the records storage area.

The Records Log Form contains information on the storage location of your files, as well as a description of the record and disposal date.

• An example of the use of the Records Log Form is the management of accident and injury records. As these records must be kept for five years, they will need to be filed away. By noting their location on the Records Log Form, retrieval when needed will be made easier. The Records Log Form will also tell you any actions, such as disposal, that have been taken with these records.

• Table 1: Jefferson Lab Records Schedules

This Records Schedule is acceptable guidance for determining retention requirements, and should be used when conducting your inventory. The table of contents is included in Table 1.

o Schedules that may be of use include Schedule I which contains information for Civilian Personnel Records, including medical records and personal injury records.

• Request for Records Disposition Authorization

This form (not included) may be used to request a disposition schedule from the DOE when records at hand do not appropriately fit into established schedules. This form is typically used by the Records Manager for correspondence with the DOE, and will seldom be used by other staff.

For further assistance with these forms or documents, contact the Jefferson Lab Records Manager at ext. 7805.

Figure 1: Records Inventory and Disposition Schedule (RIDS)

Figure 2: Records Disposition and Retrieval Request (RDR) Form

Figure 3: Records Log Form

Table 1: Jefferson Lab Records Schedules Table of Contents

Schedule	I.	Human Resources
Schedule	II.	Business Services (Procurement and Finance)
Schedule	III.	Environment, Health, Safety, and Quality/Occupational Medicine
Schedule	IV	Facility/Facilities Management
Schedule	V.	Project Costs, Inventory and Accounting
Schedule	VI.	Research and Development (Physics and Accelerator) Project Records
Schedule	VII.	R&D Program Management Records
Schedule	VIII.	R&D Collaborations and Technology Transfer
Schedule	IX.	Legal, Auditing, and Administration
Schedule	X.	Director/Public Relations

1.0 Revision Summary

Revision 0.1 – 08/13/14 – Periodic Review – Updated TechPOC from S.Smith to T.Johnson

ISSUING AUTHORITY	TECHNICAL POINT-OF-CONTACT	APPROVAL DATE	REVIEW DATE	REV.
ESH&Q Division	Tina Johnson	08/13/14	08/13/17	0.1

This document is controlled as an on line file. It may be printed but the print copy is not a controlled document. It is the user’s responsibility to ensure that the document is the same revision as the current on line file. This copy was printed on 11/5/2014.