Thank you for taking the time to complete this form. This information will assist our Facilities Operation Department in identifying and preparing space for your future research needs and requirements. Name First Last Email PhoneHWCOE Dept.BMECHEMCISEECEESSIEISEMSEMAEBrief Description of Your ResearchResearch Laboratory RequirementsIn 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 NotesRadiological Irradiator Sealed Source Radioactive Materials/Waste X-ray Laser Other None If Other, please list Other Radiological NotesCompressed GasesSelect 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 NotesChemical Flammable or Combustible Liquids Oxidizing substances Organic peroxides Toxics Reactives or Corrosives Water Reactive Metals Organometallics Cryogenics Acids or Bases Perchloric Acid Work Hydrofluoric Acid Work Acute Toxicity (Inhalation) Heated Acid Digestion Other None If Other, please list Other Chemical InformationOther Requirements Dust/airborne particulates Explosives High voltage electrical equipment Hot work (welding, cutting, brazing) Machine-shop type equipment (grinders, lathes, drill press) Heavy equipment operation (forklift, aerial lift, rigging, tractor/trailering) Paint or spray booth Engineered nanoparticles Other None If Other, please list Additional Lab Requirements InformationStandard Equipment RequirementsThe 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?YesNoWill you need a BioSafety Cabinet?YesNoWill you need a fume hood?YesNoType of hood neededChemical Fume HoodAcid Digestion Fume HoodWill you need an autoclave?YesNoWill you need a Glovebox?YesNoWill you need any Refrigeration?YesNoType of Refrigeration Needed (select all that apply) -80 Freezer -20 Freezer Standard Refrigerator Other If other refrigeration equipment is required, please list Special Equipment RequirementsPlease 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?YesNoEquipmentSpecial Voltage Requirements Do you have any equipment with special space requirements? (i.e., large foot print, clearance, floor mounted)YesNoEquipmentSpecial Space Requirements Do you have any equipment with special exhaust needs? (i.e., dedicated exhaust, snorkel, fume hood, canopy)YesNoEquipmentExhaust Requirements Do you have any equipment that relies on other equipment to run? (i.e., chilling unit, large UPS, or operating workstation)YesNoEquipmentAdditional Attached Equipment Do you have any equipment that requires special utility attachments? (i.e., compressed gas, vacuum, compressed air)YesNoEquipmentSpecial Utility Needed Ready to Submit?Has this form been completed?* All information has been collected and this form is ready for submission.