APPENDIX O: SAMPLE PRIOR APPROVAL FORM
Name: _____________
Date: _____________
Email: _____________
Phone: _____________
PI/Researcher: _____________
Building & Room Number: _____________
Material information: _____________
Material Name: _____________
CAS#:_____________
Amount of material: Choose an item.
Form: Choose an item.
URL to SDS: _____________
Hazards:
☐Explosive ☐Flammable ☐Corrosive (strong acid/base)
☐Toxic
☐Biohazard level 2 or higher ☐Water reactive
☐Other: Click here to enter text.
☐Carcinogen ☐Oxidizer
☐Pyrophoric ☐Flammable gas
Proposed Use of new Material: (Brief Summary of the SOP including where the materials will be
used and with what lab equipment)Click here to enter text.
Storage: (Where will the material be stored? Are additional controls needed?)Click here to
enter text.
Waste: What will be the waste disposal procedures for this material?Click here to enter text.
Additional information: (Please provide any additional information EH&S should be aware of
regarding this chemical or its use. Click here to enter text.
Check each box once completed:
☐I have obtained and read the SDS
☐I have ordered the PPE required to use this material safety
☐I have an appropriate spill kit to handle the release of this material
Submit to EH&S