Research Space Needs Analysis Form - Office of Facilities Operations

Name

First Last

Email

Phone

HWCOE Dept.

Brief Description of Your Research

Research Laboratory Requirements

In each category below, select any requirements that would apply to your research lab space.

Biological Materials

Human Blood or OPIM
Human Pathogen
Animal Pathogen
rDNA
Plant Pathogen
Non-Infectious
Other
None

If Other, please list

Expected Monthly Volume of Biological Waste Generated?

Other Biological Materials Notes

Radiological

Irradiator
Sealed Source
Radioactive Materials/Waste
X-ray
Laser
Other
None

If Other, please list

Other Radiological Notes

Compressed Gases

Select any of the following that you will be using in a container larger than lecture bottle size

Flammable gas (i.e., acetylene, butylene, ethane, ethylene, hydrogen, methane, propane, silane)
Non-flammable gas (i.e., argon, carbon dioxide, helium, krypton, neon, nitrogen, xenon)
Oxidizing gas (i.e., chlorine, fluorine, oxygen)
Corrosive gas (i.e., ammonia, hydrogen chloride, sulfur dioxide)
Toxic gas (i.e., boron trichloride, carbon monoxide, chlorine, chlorine trifuoride, hydrogen fluoride, phosgene)
Highly hazardous/toxic (i.e., arsine, chlorine, cyanogen, diborane, ozone, phosphine)
Other
None

Please List Other Compressed Gas Requirement

Additional Compressed Gas Notes

Chemical

If Other, please list

Other Chemical Information

Other Requirements

If Other, please list

Additional Lab Requirements Information

Standard Equipment Requirements

The above information helps us better understand what standard equipment you will need in your research space. Below is a list of standard laboratory equipment. Please identify the equipment that you know you’ll need in your research space.

Will you need a tissue/cell culture room?

Will you need a BioSafety Cabinet?

Will you need a fume hood?

Type of hood needed

Will you need an autoclave?

Will you need a Glovebox?

Will you need any Refrigeration?

Type of Refrigeration Needed (select all that apply)

-80 Freezer
-20 Freezer
Standard Refrigerator
Other

If other refrigeration equipment is required, please list

Special Equipment Requirements

Please list any equipment that has voltage requirements higher than 110V, large space requirements, special exhaust, excessive heat, requires other equipment to run such as a chilling unit, needs special utilities (i.e., vacuum, compressed gas).

Do you have any equipment with special voltage requirements higher than 110v?

Equipment	Special Voltage Requirements

Do you have any equipment with special space requirements? (i.e., large foot print, clearance, floor mounted)

Equipment	Special Space Requirements

Do you have any equipment with special exhaust needs? (i.e., dedicated exhaust, snorkel, fume hood, canopy)

Equipment	Exhaust Requirements

Do you have any equipment that relies on other equipment to run? (i.e., chilling unit, large UPS, or operating workstation)

Equipment	Additional Attached Equipment

Do you have any equipment that requires special utility attachments? (i.e., compressed gas, vacuum, compressed air)

Equipment	Special Utility Needed

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