Laboratory Space Modification Form
We look forward to working with you to promote a safe laboratory working environment.

Please answer the trigger questions below related to proposed modifications to existing laboratory space or a non-laboratory space destined to become a laboratory, including changes related to animal housing, new equipment, operations, chemicals, biological & radiological hazards.

This checklist should be completed as soon as possible in the pre-design process before initiating work. This checklist will help determine if any of the proposed changes require additional review(s), support or consultation to ensure that the space meets all applicable Codes, Standards, Regulations and Guidelines.

After receiving your submittal, EHS, Plant Construction Services, Facilities Management, or AEC (as applicable) will schedule a consulting visit or call to further discuss these proposed modifications. You may contact us at 647-1143 or visit our website at http://ehs.umich.edu/ for questions or additional information.

Person Submitting this Form *
Your answer
Email of the Person Submitting this Form *
Your answer
Lab Director (or PI) *
Your answer
Customer Contact Name *
Your answer
School/College/Institute*
Department *
Your answer
Building *
Select the name of the Building where the work will take place.
Unlisted Building
Enter an unlisted building where the work will take place.
Your answer
Room(s) *
Your answer
Please note all Hazardous Materials currently used/stored in this space? (Check all that apply.)
Please note all specialty Laboratory Equipment currently in this space? (Check all that apply.)
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