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LABORATORY CHECKOUT FORM1

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U.S.A. forms for Tennessee Technological University

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AUGUST 2015
1
LABORATORY CHECKOUT FORM
Principle Investigator/Faculty: ________________________________
Building: ___________________________________________________
Lab(s): _____________________________________________________
Chemicals
Evaluate all chemicals for transfer or waste disposal.
Transfer surplus chemicals to other Principle Investigator/Faculty.
Name of Principle Investigators/Faculty receiving the chemicals: ___________________
Dispose of waste chemicals.
Contact EHS for destruction of Select Agent Toxins.
Contact EHS for destruction of DEA controlled substances.
Return gas cylinders to supplier (non‐returnable cylinders may be disposed of through EHS).
Radioactive Materials, X‐Ray Machines, Lasers
Inform the EHS of your intended move/departure.
Transfer surplus radioactive stocks or sealed sources to another authorized Permit within TTU
and remove item(s) from inventory/registration.
Dispose of all waste radioactive material through EHS.
Decontaminate and wipe test all areas of laboratory.
Biological Materials
Inform the EHS of your intended move/departure.
Request decontamination of biosafety cabinets through EHS.
Remove biohazardous materials (cultures, frozen stocks, tissues, etc.) by proper transferring to
another investigator, autoclaving or incineration as appropriate. Contact EHS for assistance.
Clean and disinfect all laboratory surfaces and equipment.
Submit forms to Sarah DiFurio at sdifurio@tntech.edu or Box 5041.
AUGUST 2015
2
Housekeeping
Clean and decontaminate laboratory equipment (including chemical fume hoods).
Clean and decontaminate all laboratory surfaces.
Ensure that all garbage, laboratory supplies, glassware, books, binders or debris are removed
from the laboratory.
Equipment to be sent to surplus has been properly decontaminated.
Final Laboratory Walk‐Through and Clearance
Laboratories are cleared for checkout, change in use, or renovation after sections below are signed by
Principle Investigator/Faculty, Department Chair, and EHS representatives. Any outstanding issues
must be resolved prior to final decommissioning.
Walk‐Through Observations / Notes:_______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
A new researcher may not take possession of the laboratory until approved by all parties listed below.
_____________________________________________________________________________________
Principle Investigator/Faculty Signature Date
_____________________________________________________________________________________
Department Chair Signature Date
_____________________________________________________________________________________
EHS Signature Date
Submit forms to Sarah DiFurio at sdifurio@tntech.edu or Box 5041.
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Completed 18 March 2020

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