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Environmental Health and Safety

Laboratory Cleanout Request Form

To request removal or relocation of laboratory equipment or furniture, please complete this form.
Risk Management will contact you to arrange final approval.

For more information on this program, see the Laboratory Cleanout Guidelines.

Note: If you will be using 2Fix to request equipment relocation or removal, you must also submit a 2Fix request. This form is for safety clearance only.

   
   
   
PI who oversees and/or owns items for removal

Building and Room Number(s)

Please list or describe the type of items requested to be removed or relocated (e.g. autoclave, centrifuge, flammable chemicals, biosafety cabinet, etc.)

   
   
   
   
   
   
   
   
   
Check all that apply
Include cleaning agent/method used, who performed the cleaning, and when