Restricted Gas Authorization Request
In order to provide a safe U-M research environment, EHS has instituted a program with U-M Procurement Services which requires approval for specific hazardous gas purchases. Approval must be obtained to purchase the gases listed below in cylinders larger than a lecture bottle.

 The following hazardous gases, in cylinder sizes larger than a lecture bottle (size LB), are included in this policy:  carbon monoxide, flammable gases (e.g. hydrogen >5%), corrosive gases (e.g. ammonia), oxidizing gases (e.g. liquid oxygen, oxygen >25%,  nitrous oxide, chlorine, fluorine), pyrophoric gases (e.g. arsine, disilane, diborane, germane, phosphine, silane), and toxic and highly toxic gases per NFPA 55.

Beyond this approval process, all hazardous gases must be used in compliance with NFPA 45 and NFPA 55. Under no circumstance should a researcher purchase more than a 1 year supply of any gas. Contact EHS at (734)647-1143 for additional information.

The Following Are Exempt From This Policy:  Lecture bottles, Hydrogen ≤ 5% with inert gas balance.

The following departments are exempt because they are already under restrictions and audits through separate programs:   Lurie Nanofabrication Facility (LNF), Facilities and Operations department, Hospitals and off-site clinics, and School of Dentistry patient clinics.

Departments must complete this authorization form to purchase any of the restricted gases.  EHS will email the approval to the requester and notify the Strategic Supplier.  Additional information on the policy can be found at:  https://ehs.umich.edu/research-clinical/chemical/compressed-gas/

It is the responsibility of the Department to contact the supplier, place the order, and provide the necessary delivery instructions.
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Email *
Person completing this form *
Lab or Shop Director (or PI) *
Lab/Shop Contact Name regarding gas order *
Lab/Shop Contact Phone Number (xxx) xxx-xxxx *
School/College/Institute*
Department Name *
Building where the gas will be located. *
Select the name of the Building where the gas will be located.
Building Name (if not in list above)
If the building was not found in the list above, enter the unlisted building name where the gas will be located.
Room the gas(es) will be located in: *
Gas 1: Check all that apply. *
Also note that your inventory of compressed gases and other chemicals MUST be in the MISP: https://ehs.umich.edu/research-clinical/mi-safety-portal/ 
Required
Gas 1: Description (components and concentrations): *
Gas 1: Number of cylinders: *
Gas 1: cylinder gas volume in cubic feet at NTP *
Gas 2: Check all that apply.
Also note that your inventory of compressed gases and other chemicals MUST be in the MISP: https://ehs.umich.edu/research-clinical/mi-safety-portal/ 
Gas 2: Description (components and concentrations):
Gas 2: cylinder gas volume in cubic feet at NTP
Gas 2: Number of cylinders:
Would you like to request one year standing approval (this would allow you to reorder as the primary cylinder is near empty).
Clear selection
If "Yes" for standing approval, list the gas and how often you expect to replace the cylinder
Name of Gas Supplier
Clear selection
Short Code to be used
A copy of your responses will be emailed to the address you provided.
Submit
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