Room Sign Request Form

Last Revised: October 15, 2024

Each laboratory has a room sign that provides safety information to visitors and housekeeping personnel (see figure on reverse side). The principal investigator is responsible for assuring that appropriate warning information is included on this sign. Room signs are delivered via intercampus mail using the information specified on the completed form.

For PSOM laboratories, room signs forms must be completed here.

The sign is composed of 4 sections:

Section 1

Building Name

Check here if building is located in HUP

Room Number

Department

Section 2

Principal Investigator Last Name

Principal Investigator First Name

Other Researchers in the Laboratory (up to 8)

Last Name	First Name	Operations
Last Name	First Name

Section 3

Provide warning information to visitors and housekeeping personnel. Special labels are available that are placed into the boxes of this section. The labels contain icons alerting the reader that special conditions exist inside the laboratory.

Check all that apply

CAUTION-BIOHAZARD

CAUTION-DESIGNATED AREA WITHIN (Carcinogens, Reproductive Hazards, Acutely Toxic Chemicals Used WITHIN Areas of the Lab)

CAUTION–DESIGNATED AREA LABORATORY (Carcinogens, Reproductive Hazards, Acutely Toxic Chemicals Used THROUGHOUT the Lab)

CAUTION-RADIOACTIVE MATERIALS (You'll be asked the Licensee Name below)

CAUTION-LASER (You'll be asked to define the class below)

CAUTION-MAGNETIC FIELD

CAUTION-STRONG MAGNETIC FIELD (NO METAL PERMITTED)

NOT APPLICABLE (None of the above hazard warnings apply to this lab room.)

Laser Class

You are requesting a CAUTION-LASER sign. What is the laser class?

Radioactive Material Licensee

You are requesting a CAUTION-RADIOACTIVE MATERIAL sign. What is the name of the licensee?

Section 4

Evening Contact Name

Home #

Mobile #

Submitted By:

First Name

Last Name

School

Department

Building Name

Room Number

Desired Quantity of Signs

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