Pre-Commissioning Consultation Form

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We look forward to working with you to promote a safe laboratory working environment.

To begin the process, we ask that you please complete the following Pre-Commissioning Consultation Form as soon as possible after assignment of laboratory space and prior to conducting research. This form will help us determine the types of hazards you may be working with and assign appropriate staff to assist you. After receiving your submittal, EHS will schedule a consulting visit to discuss university policies, safety guidelines and training requirements related to your research. You may contact us at 647-1143 or visit our website at ehs.umich.edu for questions or additional information.

Lab Director Name:

Department:

Phone #:

Building: *

Room(s) *

Email:

Date Expected to Begin Operations:

Please mark yes or no to each item. Will you be:

Chemical Risks

Using/storing hazardous chemicals such as flammables, combustibles, corrosives, oxidizers, carcinogens, reproductive toxins, cryogenic liquids, etc.?

Yes

Using or synthesizing nanoparticles?

Yes

Biological Risks

Working with recombinant materials or biological agents (rDNA, viral vectors, bacteria, viruses, protozoa, parasite, prion, rickettsia, etc.), biological toxins, or human or non-human primate blood, cells or tissues?

Yes

You will need to fill out an IBC Registration. Click here to start the process.

Working with research animals?

Yes

Administering rDNA, infectious agents or hazardous chemicals (including FDA approved or experimental pharmaceutical products, laboratory chemicals and inhalation anesthetics) to live animals?

Yes

Radiation / Lasers

Working with ionizing radioactive materials, radioactive sealed sources/equipment with sealed sources, or any radiation-producing devices, such as, an x-ray machine, neutron generator, etc.?

Yes

Working with Class IIIB or Class IV Lasers?

Yes

Working with other non-ionizing radiation, such as UV, IR, or microwaves?

Yes

DEA Controlled Substances

Do you plan to possess/use controlled substances that are regulated by the Drug Enforcement Agency (DEA)?

Yes

Do you have any other safety or environmental concerns or questions to discuss during our visit?

If you are human, leave this field blank.

Environment, Health & Safety
1239 Kipke Drive | Ann Arbor, MI 48109-1010
Phone (734) 647-1143 | Fax (734) 763-1185
Office Hours 7:00 am – 4:00 pm

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