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Lab Relocation or Closure Notification

Use this form to notify Environmental Health & Safety (EH&S) at least three (3) weeks prior to:

  • Lab relocation to new facilities
  • Permanent closure of a lab
Contact Information

Principal Investigator:

Old phone:
New phone:
PI's e-mail address:
    
Lab Manager: (primary point of contact)
Old phone:
New phone:
Lab Manager's e-mail address:
    
Department:

 Date of move:
  

Old Laboratory Locations

Building:
Rooms:
Building:
 Rooms:
N/A
  

New Laboratory Locations

Building:
Rooms:
Building:
 Rooms:

Hazard Information

Radioactive materials?
Yes     No		  
Biohazardous materials?
Yes     No		 If so, provide the Biohazardous Use Authorization number:
Hazardous chemicals?
Yes     No		  

Equipment to be cleared:

List equipment that was contaminated or potentially contaminated with hazardous materials.
  Refrigerator
  Freezer
  Other:   List below:

                           

Additional Comments, Questions or Special Requirements
 
Submitted by:

Please review the information above and "Submit" if correct.

Environmental Health & Safety, (336) 716-9375
Wake Forest University Health Sciences