Last Revised: January 31, 2022 You must have JavaScript enabled to use this form. This form is to notify EHRS of an upcoming lab move or closure. This form may be submitted by anyone with information about an upcoming lab move or closure. It should be submitted as soon as possible so that we can help lab occupants to responsibly shutdown operations and prepare to vacate. This notification will be distributed to the appropriate EHRS staff for follow-up. The PI and Lab Safety Coordinator may be contacted directly by EHRS staff and may receive a notice regarding a BioRAFT self-inspection requirement to prepare the space for the upcoming move/closure. Refer to these Lab Close-Out Procedures for tasks that are required before the lab is vacated. This is not a lab clearance request. If you wish to submit a lab clearance request have a space cleared prior to renovations or in preparation for a new occupant use this form: Lab Clearance Request Form Reason for lab closure or move Reason for lab closure or move - Select -PI retiring or lab closureLab moving to another institutionLab moving within PennOther… Please explain Building and room numbers where lab is moving Anticipated Date of Vacancy (approximate) Optional: Notes about anticipated vacancy date Who is completing this form? First and Last Name Email Address Are you submitting this form on behalf of another individual? Lab Information BioRAFT Lab Name (PI name, Core, etc.) First and Last Name of Person Responsible for Lab (PI, Director, etc.) Email Address of Person Responsible for Lab Optional: Name of Alternate Contact for Lab (e.g. lab manager) Alternate contact email address Building Name(s) Room Numbers to be Vacated Remaining Staff I confirm that no staff will be left behind after our lab's departure or move. Members of lab staff will remain after PI's departure or lab move. Name of lab members remaining in space to continue operations. Include spaces if applicable. Are remaining staff staying temporarily or permanently? If temporarily, list month and date of depature. Select all hazardous materials and equipment types in the lab I don't have this information None Chemicals and/or gases Biological materials Biosafety cabinets Ductless (filtering) fume hood (This is a free-standing bench-top fume hood that is not ducted to the building exhaust system.) Laminar flow cabinet/laminar clean bench Radioactive materials Radiation producing equipment Lasers Controlled substances Other materials or equipment of concern Please explain If you have any other information about this lab closure or move, please provide it below CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
