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Laboratory Hazard Sign Request Form

Please fill out 1 form for each lab. Your sign will be posted in 5-10 business days.

Location Information:

Building Number of Entrances to lab:
Room

Principle Investigator Information:

Title (Dr., Mr., Ms., etc.)

  Name
  Office Location
  Work Phone
  E-Mail
  After Hours Phone* 

Alternate Contact Information (Lab Manager, etc)

Title (Dr., Mr., Ms., etc.)

Name
Office Location
Work Phone
E-Mail
After Hours Phone* 

*List after hours  phone numbers for contact in the event of an after hours emergency.  These numbers will not be posted on your sign but will be accessible to Work Control Center and Emergency Responders through the EH&S database.  

Check off up to seven of the following (six hazard and at least one personal protective equipment categories).

A NFPA 704 diamond will automatically be added to signage for labs with hazardous chemicals or compressed gases:

Personal Protective Equipment-
Check at least 1
Eye Protection Required at All Times       
Eye Protection Required When Chemicals In Use     
Eye Protection Required When Lasers In Use
Eye Protection Required When Using Power Tools             
Eye Protection Required When Chemicals/Lasers In Use
Eye Protection Required When Chemicals/Power Tools In Use
Wear Protective Clothing            
No Open Toe Shoes              
No Eating or Drinking
Bio, Chemical, Radioactive and Physical Hazards-
Check up to 6 
 Biosafety Level 1        
Biosafety Level 2              
Biosafety Level 3       
Animal Biosafety Level 2
Animal Biosafety Level 3

    
     

 Corrosive Materials
Toxic Chemicals
Flammable Solvent
Explosives
Compressed Gas
Toxic Gas
Flammable Gas
Cancer Hazard		 Radioactive Materials
X-Ray Equipment
Radiation Producing Equipment
Microwave Radiation
Cryogenic Hazard
Electrical Hazard
High Voltage
Laser Light
Ultraviolet Light 		 
           Comments or Additional Label Requests:

Environmental Health & Safety.
Revised: January 20, 2011