Initial Notification Form 

Use this form to notify Environmental Health & Safety (EH&S) at least three (3) weeks prior for one of the following.  Please check which box(es) apply.


(Closeout of the PI's lab and transferring inventory and/or room to another PI within the institution.) 
Name of PI that the inventory and/or room will be transferred to:
Laboratory Building/Room(s): 


(Closeout of the PI's lab. Inventory and/or room will not be going to another PI within the institution.)
Laboratory Building/Room(s): 


FROM Laboratory Building/Room(s): 
TO Laboratory Building/Room(s): 

(The PI is adding room(s) to his/her current lab locations.)
Add Laboratory Building/Room(s): 
Add Laboratory Building/Room(s): 
Add Laboratory Building/Room(s): 

CONTACT INFORMATION

Principal Investigator:   
Old Phone:   
 New Phone: 
PI's e-mail address:   
Lab Manager:  (Primary point of contact)   
Lab Manager's e-mail address:   
Department:
 Date of Move:  
 

HAZARD INFORMATION

Radioactive Materials?      
  
Biohazardous Materials?      
If so, provide the Biohazardous Use Authorization number:
  
Hazardous chemicals?      
    
Equipment to be cleared:     

List equipment that was contaminated or potentially contaminated with hazardous materials.

Additional Comments, Questions or Special Requirements:



Submitted by:  

  

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

Quick Reference

Emergency Security
Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.