Hazardous Work Registration Form
Please click the following URL to access the Hazardous Work Registration form:*Internet Explorer is not supported.Please use another browser.

You can also access the form from: the website of the Occupational Welfare Division/Health Care Office → 健康診断 → 職員健診 → Health Checkup for Who are engaed in Hazardous Work → Hazardous Work Registration Form
You are required to register your e-mail address first, and you will then be sent an e-mail with the URL to access the registration form.
Please follow the instructions below to complete and submit the form.
Note: Please do not forget to set the e-mail address “810hoken@mail2.adm.kyoto-u.ac.jp” as a receivable e-mail address.

1. Register your e-mail address on the Web Form page.
Leave the “Subject” field blank.
Enter your e-mail address in the “mail” field, and click the “Submit” button. Please note: the e-mail address must be accessibleby the university’s internal system.

Leave the “Subject” field blank.
kyodai.taro@mail.com

The following page will be displayed:

2. Confirm that you have received the confirmation e-mail.
A confirmation e-mail like the one below will be sent to the e-mail address you registered on the Web Form page. Access the URL
provided in the e-mail prior to the expiration date. Please note that the URL must be accessed via the university’s internal system.

Regardless of the date described in the email, click the URL on theday to register. (Please restart from 1 when the expiration date hasexpired.)3. The Registration page will be displayed. Select or enter appropriate information in each field.

The expiration date provided in the e-mail is displayed here.
The e-mail address you registered is displayed here.
Select male or female in the “Gender” field.
Enter your birthday (in YYYY-MM-DD format) in the “Date of birth” field.
Enter your name in full-width katakana, with a full-width space between first and last names, in the “Name (kana)” field.
Enter your name in kanji, with a full-width space between first and last name, in the “Name” field.
Enter “Temporary” in the “Job title” field.

Select “Temporary staff” in the “User category” field.

Enter your department in the “Department” field.

Enter your work area in the “Work area” field.
When you click the “contents” field, the “Hazardous Work Registration Form” will bedisplayed. Please see the following pages for details of how to complete the form.

The Hazardous Work Registration form will be displayed. The form has four tabs to register the details of hazardous work.
Please enter the information in the tabs from left to right (Applicant → Substances → Job → Details).

3-1. Please enter the required information in the “Applicant” tab.
The information you entered in the “Registration” page is automatically displayed in the “User Info” fields. Please check theboxes to indicate all measures taken and protection items used in the course of your work (if any) in the “Measures” field.

The information entered in the previous
page is automatically displayed here.

Please check the boxes to indicate allmeasures taken and protection items used in
the course of your work (if any)

3-2. Please check the checkboxes ☑ of substances handled in the course of your work (multiple
selections allowed).

You can narrow down the search results by typing a part ofthe category or name of the substance.
Example: Specified chemical substances
DustBenzineTrichlorethylene

3-3. Select the tasks you will be engaged in and enter the necessary information in the “Tasks” tab.
Based on the substances you selected in the “Substances” tab, the checkboxes of the tasks related to the substances are alreadychecked automatically. Enter the required information in the “Usage days per year” and “Average usage hours per day” fields.

Multiple selections are allowed.

2006

3-4. In the “Details” tab, select or enter the detailed information for the substances handled and thetasks you will engage in.

Please complete allof the fields.

3-5. After entering the required information in all four tabs, click the “Save” button.

3-6. If an error message is displayed, click the error message. The field containing the error will behighlighted in pink. Please re-enter the information correctly in the field.

Click the error message, and the field containing
the error will be highlighted in pink.

4. Return to the Registration page.
The information registered in the Hazardous Work Registration form is entered in the “Contents” field of the Registration
page. (If you wish to confirm the information registered in the Hazardous Work Registration form, click the “Contents” field
to open the form again.)
After confirming that the information is entered correctly in all of the fields, click the “Submit” button.

5. The Registration form is submitted correctly.

If there is an error in the submitted registration form, or if you need to change its content, please redo the registration from the beginning (i.e. from step 1 on
page 1). The previous entries will be overwritten with the newly submitted information.