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EH&S: Laboratory - Fume Hood Use Questionnaire

Upon request by PPS or EH&S, the following form must be completed by lab personnel prior to PPS conducting any maintenance activities requiring work inside potentially contaminated ducts and plenums.
User Information
Fume Hood Location
Workers conducting maintenance on your hood are required to enter ducts that may potentially be contaminated. Although there are a large variety of chemicals used in fume hoods, some fume hood use outlined below may pose a greater risk to maintenance personnel. Please fill out the form to the best of your knowledge by checking the appropriate box and providing additional information where required.
Identify the isotope(s), date that they were last used and the activity being performed
Identify the agent/material(s), frequency of use and amount and if any spore forming bacteria have been used in the fume hood.
Identify the chemical formula(s) and quantity
Identify the chemical formula(s) and quantity