Lab Signage FormLab InformationBuilding *Room/Lab # *Department *Department Head/Chair *Is this lab shared by more than one PI? YesNoPrinciple Investigator (PI) Emergency Contact InformationPhone *Equipment currently used in the lab *LasersParticle Accelerator/X-Ray/Fluoroscope, E.M. (ionizing radiation equipment)NMR/MRI/Super Conducting MagnetsUV Lights - Metal Halide, High pressure xenon, Mercury Vapor, or other 'blue light' producing lampHigh Voltage DevicesCryogenic Gas - bulk tank or hard-pipedNoneOther/explainTypes of agents used in the lab *Radioactive MaterialsBiohazard MaterialsNoneOtherIf using biohazard materials, please select type *Human BBPNon-Human primate tissueOther animal tissues, cells, bloodRecombinant DNASynthetic DNAViral VectorTransgenic AnimalsBio-nano ParticlesPrionsParasitesPlantsInsectsBacteriaVirusFungusUSDA-regulated agents/animalsCDC Select AgentsOtherNoneChemical Hazards Please select any chemicals not currently listed in your inventory.CorrosivesHydrofluoric AcidPerchloric AcidKnown, potential, or reasonably assumed to be Human CarcinogensFlammable MaterialsReproductive or Mutagenic HazardsTeratogensHepatotoxinOxidizerCompressed Gas CylindersLecture BottlesMercury CompoundsToxic - LD <50 mg/kg (e.g., cholinesterase inhibitors)ExplosivesWater Reactive CompoundsMinimum PPE Required for Entry *Gloves at all timesLab coat at all timesGloves when workingLab coat when workingFace/Eye ProtectionClosed-Toe ShoesHearing ProtectionRespiratory ProtectionShoe CoversSleeve CoversTyvek suitOther/explainWhat equipment will your research require? *AutoclaveBiosafety CabinetChemical Fume HoodPerchloric Fume HoodGlove BoxSnorkel ExhaustVentilated Powders CabinetOtherSpecial Interest Materials and/or ChemicalsAre you using OSHA Regulated Chemicals? YesNoAre you using Department of Homeland Security Chemicals of Interest? YesNoAre you using materials regulated by the Drug Enforcement Administration? (drugs or chemicals) YesNoPlease specify any requested alterations required to this signage (addition or removal of hazard symbols, updated diamond information, etc.) Provide description of changes.Date this form was completed * VerificationPlease enter any two digitsExample: 12This box is for spam protection - please leave it blank:
