FORMS INDEX
04.01
Revised 1-22

For more information contact:
    Procedures, Records, and Forms
    509-335-2005

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Manual Section Reference	Title / Primary Purpose	Formats Available
85.33	Administrative Information Systems Access Request (View Only) (WSU1350) 1-22 To authorize, remove, or change an employee’s view only access to AIS application(s).	PDF
95.05	Guarantee for Advance of Funds to Nonemployee Student (WSU1499) New 1-21 To request an exception to the travel advance policy to advance funds to a nonemployee student.	PDF
60.21	Accommodation Request for Disability or Serious Medical Condition (WSU1453) Rev. 4-09 To request reasonable accommodation for an employee or individual with disabilities or a serious medical condition.	PDF
60.44	Annual Report of Outside Compensation for Faculty (WSU1329) Rev. 01-22 Used to report faculty outside professional activity.	PDF
60.55	Annual Review: Administrative Professional Employees (WSU1389) Rev. 7-16 Documents current administrative professional employee performance.	PDF FileMaker
60.11 60.17	Applicant Self-Identification (WSU1296) Rev. 11-96 To indicate minority status of job applicants.	Online Position Description and Recruitment System (OPDRS) website
60.38	Area Evaluation/Release (WSU1449) Rev. 4-06 To certify that an area has been decontaminated, that hazardous materials have been removed, and that the area is ready for release to Facilities Services, Operations or new occupants.	PDF
30.70	Auction Bid Gift Transmittal (WSU1444) Rev. 1-21 Accompanies multiple gifts received by WSU units at auction fundraising events and routed to WSU Foundation—Gift Accounting.	PDF
30.70	Auction Item Gift Transmittal (WSU1445) Rev. 1-21 Accompanies multiple noncash gifts received by WSU units at auction fundraising events and routed to WSU Foundation—Gift Accounting.	PDF
45.75	Authorized User Questionnaire (WSU1490) Rev. 12-13 Required to screen applicants requesting authorized user access to controlled substances.	PDF
30.65	Bank Account Request (WSU1291) Rev. 6-09 To request authorization to establish a commercial bank account.	PDF
85.48	Business Objects Data Warehouse Access Request (WSU1476) Rev. 01-21 To obtain approval for specified departmental personnel to access the business objects student and financial data warehouses.	PDF
95.45	Certification of Exception to Fly America Act (WSU1501) Rev. 1-21 To request approval for an exception to the Fly America Act.	PDF
5.66	Chemical Collection Request For proper disposal or recycling of chemical substances.	WSU Environmental Health and Safety website
45.75	Controlled Substance Inventory Record (WSU1491) Rev. 12-13 Used to document the inventory of controlled substances on hand at a registered location.	PDF
80.05	Copy Center Work Order (WSU1091) Also called the Fast Copy Order. Request for service when a blanket IRI is on file.	Paper: University Publications & Printing
70.40	Cost/Benefit Analysis (WSU1483) Rev. 7-19 Used to compare the cost of purchasing a vehicle versus long-term lease of a vehicle through the Motor Pool.	PDF
30.70	Gift Records Cover Sheet (WSU1500) New 1-21 Accompanies each envelope containing gift deposits from WSU units, which are dropped off at any of the University courier service locations to be delivered to WSU Foundation—Gift Accounting.	PDF
30.55	Credit Card Refund Voucher (WSU1381) Rev. 10-99 To refund purchases paid by credit card.	PDF
60.30	Cyclic Year Memorandum (WSU1320) Rev. 12-20 To notify employees of cyclic year.	PDF
30.59	Daily Reconciliation Sheet (WSU1398) Rev. 4-16 To compare and balance the register receipts and adjustments against the money on hand at the end of the day.	PDF
60.74	Departure Checklist (WSU1464) Rev. 12-20 To document the completion of required personnel, payroll, computing, financial, facility, property, safety, and research-related procedures when an individual resigns, retires, or is separated from the University.	PDF
60.38	Departure Notice (WSU1448) Rev. 1-21 To notify the Radiation Safety Office and Environmental Health Services of an impending departure of a user of hazardous chemicals or materials.	PDF
45.53 70.44	Distribution Log for Payments of Cash, Gift Cards and Other Cash Equivalents, and Tangible Property (WSU1496) Rev. 8-20 To maintain a log of incentive payments made to research participants.	PDF
30.70	Drop-Off Receipts (WSU1465) Rev. 5-10 To provide WSU unit representatives with documentation of receipt of gift deposit envelopes by courier service drop-off site representatives.	PDF
90.50	E-Signature Use Exception Request (WSU1504) New 10-19 To request exceptions to University e-signature use restrictions.	PDF
60.55	Employee Performance Evaluation (WSU1451) Rev. 7-06 Documents current civil service employee performance.	Human Resource Services website PDF FileMaker
60.04	Employment Eligibility Verification USCIS Form, I-9 Employee identifies them self and establishes eligibility for U.S. employment.	Human Resource Services website
60.19	Employment Record Request (WSU1238) Rev. 8-05 To request employment records from former state employees.	PDF
90.15	Essential Records Schedule (WSU1457) Rev. 10-05 Used to maintain a list of departmental essential records and applicable protection instructions.	PDF
30.75	Establishment of Fund To establish a gift account fund.	Paper: College development officer
30.25	Expenditure Transfer Request (WSU1048) Rev. 12-06 To transfer identifiable direct charges between funding sources.	Paper: US Item #49882 PDF FileMaker
80.10	Faculty Textbook Order Sheet Used by faculty to order student textbooks and supplies.	Paper: Bookstore
3.34	Fall Protection Work Plan Rev. 10-92 To document actions taken to prevent falls. Required when working ten feet or more above the level below.	PDF
20.78	Federal Excess Property Request (WSU1303) Rev. 2-08 To request federal excess property.	PDF
10.26	Federal Lobbying Activity Quarterly Report (WSU1366) Rev. 8-06 To report federal lobbying efforts.	Government Relations website
95.37	Fuel Card Application (WSU1480) Rev. 1-21 To request approval for a University fuel credit card used to purchase fuel, emergency roadside assistance, and routine maintenance services (if approved) for University-owned vehicles and equipment.	PDF
95.37	Fuel Card Change Request (WSU1486) Rev. 1-21 To request changes to fuel credit card accounts.	PDF
95.37	Fuel Card Custodian Agreement (WSU1479) Rev. 1-21 To document employee agreement to the terms of the WSU Fuel Card program and acknowledgment of fuel card custodian responsibilities.	PDF
30.70	Gift Accounting Log Sheet (WSU1467) Rev. 7-13 To document drop-off of gift deposit envelopes at courier service sites.	PDF
30.70	Gift Electronic Funds Transfer Authorization (WSU1450) Rev. 1-21 To authorize an electronic funds transfer directly from a donor's bank to WSU Foundation.	PDF
30.72	Gift In Place Review Sheet (WSU1493) Rev. 12-13 To authorize acceptance of a gift of a completed facility, designed and constructed by a donor for the University.	PDF
30.70	Gift Payroll Deduction (WSU1447) Rev. 1-21 To authorize a one-time or ongoing gift deduction to WSU Foundation—Gift Accounting.	PDF
30.70	Gift Transmittal and Acknowledgment (WSU1218) Rev. 12-21 Accompanies gifts routed from WSU units to Advancement Services.	PDF
30.70	Golf Tournament Gift Transmittal (WSU1443) Rev. 1-21 Accompanies multiple gifts received by WSU units at golf tournament fundraising events and routed to WSU Foundation— Gift Accounting.	PDF
2.52	Hazard Notification (WSU1247) Rev. 1-09 To report safety hazards or unsafe practices.	PDF
60.21	Health Care Provider Statement for Reasonable Accommodation Requests (WSU1455) Rev. 4-09 To request written documentation from a health care provider of evaluation and recommendations for an individual requesting reasonable accommodation.	PDF
2.24	Incident Report (WSU1131) Rev. 1-08 To report accidental injury or work-related illness involving WSU employee or third party; may also be used for property damage.	Human Resource Services website
85.34	Information Technology Computing Invoice and Usage Report Notifies computer users of costs, allocations, and usage of each service.	Paper: Information Technology
70.05	Interdepartmental Requisition and Invoice (IRI) (WSU1017) Rev. 1-21 To requisition goods and services from WSU supplier departments. To set up blanket requisitions with WSU supplier departments.	PDF FileMaker
20.50	Inventory Control Report (WSU1033) Rev. 4-03 To report changes in the department's equipment inventory.	PDF FileMaker
20.77	Item Evaluation (WSU1439) Rev. 12-07 To submit laboratory, medical, or shop/ industrial items to Surplus Stores.	PDF
85.42	ITS Online Customer Billing Statement Summarizes telecommunications charges to a budget/project, grouped by type of service.	Information Technology Services website
85.42	ITS Online Customer Call Detail Report Itemizes telephone tolls and telecommunications services charged to an account.	Information Technology Services website
50.25	Key Assignment Record (WSU1210) Rev. 8-08 Record of all keys assigned to a single individual.	PDF FileMaker
50.25	Key Roster (WSU1264) Rev. 5-95 Record of all key holders in department who have been issued a specific key.	PDF
60.21	Medical Release Statement for Reasonable Accommodation Requests (WSU1454) Rev. 4-09 To request permission from an individual requesting reasonable accommodation to obtain written documentation from a health care provider.	PDF
30.57	Merchandise Credit Memorandum (WSU1311) Rev. 8-91 To credit a non-University customer's account.	Paper: Bursar's Office
60.81	Minor Volunteer Consent and Release (WSU1417) Rev. 10-04 To authorize an individual who is under 18 years of age to perform volunteer work for the University.	PDF
70.08	Missing Document Affidavit (Procurement Card Transactions) (WSU1471) Rev. 1-21 To provide documentation of a procurement card transaction in lieu of a lost purchase receipt.	PDF
85.45	Cellular Device Authorization and Agreement (WSU1474) Rev. 7-21 To justify, describe, and authorize University allowances for cellular device equipment and services.	PDF
85.37	Network Services Account Request (WSU1383) Rev. 1-22 To request, change, or terminate user IDs for network, e-mail, and view only AIS applications.	PDF
30.70	Noncash Gift Transmittal and Acknowledgement (WSU1442) Rev. 1-21 Accompanies noncash gifts routed from WSU units to WSU Foundation—Gift Accounting	PDF
30.70	Noncash Multiple Gift Transmittal (WSU1446) Rev. 1-21 Accompanies multiple noncash gifts routed from WSU units to WSU Foundation—Gift Accounting.	PDF
30.30	Nonservice Pay Authorization (WSU1314) Rev. 11-21 To authorize pay to WSU fellows, trainees, interns or other nonservice positions.	PDF
85.48	OBIEE Data Warehouse Access Request (WSU1497) Rev. 1-21 To obtain approval for specified departmental personnel to access the OBIEE data warehouse.	PDF
60.02	Organization Chart (WSU1458) Rev. 7-06 To indicate a position's relationship to other positions in a department for classification or reclassification purposes.	PDF
20.53	Physical Inventory Notification (WSU1386) Rev. 11-99 To notify Controller's Office of an upcoming physical inventory count of a merchandise or consumable inventory.	PDF
20.53	Physical Inventory Value (WSU1387) Rev. 11-99 Used to report the value of the physical inventory count of a merchandise or consumable inventory.	PDF
60.02	Position Description (WSU 1360) Rev. 7-06 Used to describe the job functions of a civil service or administrative professional position for classification or reclassification purposes.	Online Position Description and Recruitment System (OPDRS) website PDF FileMaker
60.02	Position Questionnaire (WSU1440) Rev. 7-06 Used to describe the job functions of an incumbent seeking position reclassification.	PDF
20.50	Property Inventory Card (WSU1058) Computer-generated form provides a record of acquired equipment.	Paper: Property Inventory, Controller
90.05	Public Records Request (WSU1232) Rev. 3-16 To request approval to view and/or copy WSU records.	PDF
2.46	Public-Access Defibrillator Use Agreement (WSU1477) Rev. 12-09 To request approval to install and use an automated external defibrillator (AED) in a University location.	PDF
70.08	Procurement Card Change Request (WSU1441) Rev. 1-21 To request changes regarding a departmental procurement card.	PDF
70.08	Procurement Card Check-Out Log Sheet (WSU1470) Rev. 1-21 To log the checkout and return of a procurement card temporarily checked out to a designated departmental employee.	PDF
70.08	Procurement Card Temporary Delegation (WSU1469) Rev. 1-21 Used by a cardholder to temporarily authorize another departmental employee to use a procurement card.	PDF
70.08	Procurement Card Use Exception Request - Contract (WSU1508) New 1-21 To request an exception to make a contract payment with a procurement card.	PDF
70.08	Procurement Card Use Exception Request - Entertainment (WSU1509) New 1-21 To request an exception to pay entertainment expenses with a procurement card.	PDF
70.08	Procurement Card Use Exception Request - Gift Cards (WSU1510) New 1-21 To request an exception to buy gift cards with a procurement card.	PDF
70.08	Procurement Card Use Exception Request - Group Travel or Activity Expense (WSU1511) New 1-21 To request an exception to pay for group travel or activity expenses with a procurement card.	PDF
70.08	Procurement Card Use Exception Request - Restricted (WSU1512) New 1-21 To request an exception to use a procurement card for miscellaneous prohibited purchases or payments.	PDF
70.08	Restricted Purchase Template (WSU1513) New 1-21 Used to document a prohibited purchase that was made prior with a procurement card.	PDF
95.20	Receipt Affidavit (WSU1342) Rev. 1-21 To submit to the Controller in lieu of a lost, missing, misplaced, or inadequate travel receipt.	PDF
30.52	Receipt Log Sheet (WSU1364) Rev. 1-21 To record checks and bankcard transactions in lieu of completing a WSU receipt for each transaction.	Paper: Bursar's Office
45.53 70.44	Record of Distribution and Request for Taxpayer Number and Certification (WSU1495) Rev. 1-21 To record research participant's personal identification information.	PDF
90.01	Records Retention Schedule (WSU1301) Rev. 8-94 Establishes retention periods for University records.	Paper: Procedures, Records, & Forms
55.62	Relocation Compensation Request (WSU1424) Rev. 7-21 To request a lump sum relocation compensation payment to recruit a new WSU employee.	PDF
60.10	Request for Appointing Authority Delegation (WSU1405) Rev. 2-13 To request appointing authority delegation for faculty, administrative professional, civil service, or collective bargaining unit appointments.	PDF
40.02	Request for Approval of Application for Extramural Support To request approval to submit a proposal to an off-campus funding source.	Paper: Office of Research Support and Operations (ORSO), or Automated versions from the ORSO website
50.11	Request for Certificate of Insurance (WSU1400) Rev. 10-18 To request evidence of insurance coverage for submittal to third parties.	PDF
90.75	Request for Change of Legal Sex Designation (WSU1503) New 8-19 To request a change of legal sex designation in University records	PDF
90.75	Request for Change of Name (WSU1200) Rev. 8-19 To request a name change in University records.	PDF
10.15	Request for Individual Defense by the Attorney General To initiate a request for legal defense by the Attorney General's Office.	Paper: WSU Attorney General's Office
80.24	Request for Mailing (WSU1208) Rev. 4-95 To request that mail be sent by specified special services.	Paper: Mailing Services
80.15	Request for Shipment of Merchandise (WSU1212) Rev. 1-21 To ship merchandise off campus.	WSU E-Forms System
60.58	Request to Donate Shared Leave (WSU1331) Rev. 7-09 To authorize donation of annual leave, sick leave, or personal holiday hours to another employee as allowed by the shared leave program.	PDF
70.31	Request to Serve Food (WSU1353) Rev. 1-21 To request permission to pay for food served at a University training session or meeting.	PDF
3.24	Respirator Authorization/ Respirator Fit-Testing and Training Record Rev. 2-00 To authorize the use of a respirator and provide a record of respirator selection, fit-testing, and training.	Paper: Environmental Health and Safety
90.01	Retention Schedule Review Rev. 7-96 To certify that departmental records retention schedule has been reviewed, or to request changes to a departmental records retention schedule.	PDF FileMaker
5.10	Safety Data Sheet (SDS) Request (WSU1391) Rev. 9-17 To request an SDS for each hazardous chemical in the workplace.	PDF
2.50	Safety Inspection Checklist (WSU1250) Rev. 10-07 To conduct self-inspection of department/ work area and document findings and corrective actions.	PDF
2.16	Safety Orientation Checklist (WSU1249) Rev. 1-13 To document review of safety procedures.	PDF
2.12	Safety, Health, and Security Committee Meeting Agenda and Minutes (WSU1248) Rev. 01-19 To document Level 3 and Level 4 safety committee meetings.	PDF
50.35	Security Camera System Access Request (WSU1507) New 11-20 To request access to security camera system recorded information.	PDF
30.15	Service Center Application (WSU1272) Rev. 1-21 To request approval to charge for goods, services and/or use of equipment.	PDF
30.15	Service Center Calculation Worksheet (WSU1459) Rev. 1-21 To identify, calculate, and document the components of requested service rates.	Excel
30.95	Special Course Fee Request (WSU1224) Rev. 1-21 To request, amend, or delete a special course fee.	PDF
10.25	State Lobbying Activity Quarterly Report (WSU1334) Rev. 8-06 To report state lobbying efforts.	Government Relations website
30.45	State of Washington Invoice Voucher (WSU1273) Rev. 2-21 To seek reimbursement from University accounts.	PDF FileMaker
95.35	Student Driver Authorization (WSU1188) Rev. 5-01 To authorize a student driver to drive a state vehicle.	PDF
60.73	Summer Educational Benefit Request (WSU1365) Rev. 4-16 To authorize WSU employees to take WSU summer session classes.	PDF
2.26	Supervisor's Accident Investigation Report (WSU1246) Rev. 8-97 To document accident investigation. Used when an accident results in an injury, which involves lost time from work or medical treatment.	PDF
20.76	Surplus Disposal Request Rev. 7-12 To document the transfer of surplus items to Surplus Stores.	myFacilities website
60.34	Telework Agreement (WSU1420) Rev. 6-21 Used to establish a formal agreement for a telework arrangement between the University and an employee.	PDF
60.27	Temporary Employee Orientation Checklist (WSU1279) Rev. 12-20 To orient temporary employees.	PDF
95.21	Funds Transfer Authorization (WSU1433) Rev. 11-21 To request funds transfers of Payment Services expense reimbursements.	PDF
95.03	Travel Charge Card Application (WSU1422) Rev. 1-21 Used to request a University travel charge card.	PDF
60.70	Tuition Waiver Request (WSU1082) Rev. 4-21 To authorize WSU employees to take WSU classes.	PDF
50.17	Tunnel Entry Hazard Acknowledgment (WSU1487) Rev. 10-12 To confirm that all affected employees have been informed of potential steam tunnel hazards.	PDF
95.35	Vehicle Request-Justification (WSU1278) Rev. 5-21 To request a long-term vehicle rental from the motor pool.	PDF
60.81	Volunteer Monthly Report (WSU1418) Rev. 2-21 To report total volunteer hours at end of month for workers' compensation coverage assessment.	PDF FileMaker
2.24 2.26	Witness/Injured Person Statement (WSU1315) Rev. 9-13 Used to provide a written account of an accident involving University personnel.	PDF
50.31	Workplace Bullying Incident Report (WSU1494) Rev. 9-15 To report workplace bullying incidents.	PDF
50.30	Workplace Violence Incident Report (WSU1460) Rev. 2-08 To report workplace violence incidents.	PDF
30.57	WSU Invoice (WSU1310) Rev. 5-15 To record charge sales to non-University clients.	Paper: Bursar's Office
30.52	WSU Receipt (WSU1054) Rev. 1-21 To record all external cash sales and all cash collections.	Paper: Bursar's Office
30.52	WSU Receipt Authorization (WSU1370) Rev. 5-09 To authorize University personnel to obtain WSU Receipts and Receipt Log Sheets from the Bursar's Office.	PDF
30.52	WSU Receipt Inventory Control Sheet Rev. 1-21 To provide a record of activity of the WSU Receipts issued to a department.	PDF
30.52	WSU Receipt Request (WSU1371) Rev. 1-21 To request receipting forms from the Controller's Office.	PDF
80.56	Facilities Services Equipment Review (WSU1514) New 1-22 To identify utility requirements associated with new equipment.	PDF
20.76	WSU Vancouver Surplus Report Rev. 10-11 For WSU Vancouver (WSUV) departments to document the transfer of surplus items to WSUV Facilities Operations Surplus.	WSUV Facilities Operations website