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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.

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

FUND CODE (2) - UNIT CODE (6) - OBJECT CODE (5) - PROJECT CODE (5) Eg. 12 - 123456 - 52608 - 00000

NOTE: Risk Management does not charge for screening laboratory equipment or chemical disposal, but a budget code is needed for services rendered by Facilities. Your request will not be automatically forwarded to Facilities 2FIX if you do not provide a budget number here.