NCNR Laboratory Experiment Proposal Form

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Laboratory Experiment Proposal Form

Every experiment must undergo a safety review before the experiment can be performed in the NCNR laboratories. The information supplied below will be sent to our safety review team upon submission.

Experiment Information and Contacts

Experiment Location:
Experiment Title:
Experiment Start Date:
Contact name(s):
Experimenter Contact Phone Number - Cell or Home:
Experimenter Contact Email Address:

Chemicals

List all of the chemicals to be used and their NFPA hazard levels.

		NFPA Hazard Level
Chemical Name	MSDS (PDF files, only)	Health	Flammability	Reactivity	Special Hazards

Samples

Specify any known hazardous reactants or products

Sample Name	Hazardous?	Known Hazards

Safety Equipment

Gloves:
Gloves, Nitrile/Latex Gloves, Cold Temp. Gloves, Hot Temp. Gloves, Neoprene Gloves, Sharps Gloves, Welding
Other PPE:
Safety Glasses Dust Mask Ear Plugs Face Shield Lab Coat
Fume Hoods:
Fume Hood for Acids Fume Hood for Organics
Other:
Goggles, Welding Tongs Other Not Listed - Specify in Experiment Procedure

General Laboratory Equipment

General Equipment:
Balance Centrifuge Dry Bath Drying Oven Microscope Stirrer/Hot Plate Temperature Bath
Meters:
Conductivity Meter Density Meter Humidity Meter pH Meter
Specialized Equipment:
Dynamic Light Scattering FTIR Glove Box Lyophilizer Spin Coater UV-Vis Spectrometer X-Ray Diffractometer
Other:
Atmospheric Bag Autosorb-1-C Chamber Furnace Drying Tube Glass Torch Laboratory Press Micro Mill RollerMixer Rotary Evaporator Stirred Filtration Cell Temperature Cabinet Ultrasonic Bath Ultrasonic Processor Vacuum Oven Vacuum Pump Other Not Listed - Specify in Experiment Procedure

Experiment Procedure

Please give a step-by-step procedure for the experiment to be performed.

Last modified 14-August-2012 by website owner: NCNR (attn: )