Lab Signage

Building:*

Room Number/Lab:*

Department:*

Department Head/Chair:*

Is This Lab Shared By More Than One PI?

Yes

Principal Investigator (PI):

Email:*

Enter Email Confirm Email

Phone Number:*

Equipment Currently Used in the Lab:

Lasers

Particle Accelerator/X-ray/Fluoroscope, E.M (ionizing equipment)

NMR/MRI/Super Conducting Magnets

UV Lights – Metal Halide, High Pressure Xenon, Mercury Vapor, or other ‘blue light’ producing lamp

High Voltage Devices

Cryogenic Gas – bulk tank or hard-piped

None

Other

If "Other" Selected in Above Field, Explain:

Types of Agents Used in the Lab:

Radioactive Materials

Biohazard Materials

None

Other

If Using Biohazard Materials, Please Select Type:

Chemical Hazards:

Minimum PPE Required for Entry:*

What Equipment Will Your Research Require?*

Autoclave

Biosafety Cabinet

Chemical Fume Hood

Perchloric Fume Hood

Glove Box

Snorkel Exhaust

Ventilated Powers Cabinet

Other

Are You Using OSHA Regulated Chemicals?

Yes

Are You Using Department of Homeland Security Chemicals of Interest?

Yes

Are You Using Materials Regulated by the Drug Enforcement Administration (Drugs or Chemicals)?

Yes

Please Specify Any Requested Alterations Required to This Signage (Addition or Removal of Hazard Symbols, Updated Diamond Information, etc.):

Provide description of the changes.

Date This Form Was Completed:

This field is for validation purposes and should be left unchanged.

Lab Signage

Lab Signage Form