Laboratory Relocation/Closure Notification

							                                                                            Laboratory Relocation/
                                                                             Closure Notification
Use this form to notify University support units of your impending relocation. Please allow at least 30 days, more
time may be required to satisfactorily complete your relocation/closure. Please return this form to the assigned EHS
Specialist via e-mail or Campus Mail to bldg. 605.

NOTE: Timely submittal of this form allows update of records required by granting and regulatory agencies, and will
permit continued use of materials such as radioisotopes without interruption.

                                                 Lab Manager/
 Date:                                           Point of Contact:

 Telephone:                                      Email:
 Estimated
 move out date:                                  Department:
      Current Laboratory                         Building Name/Number:

 Room Numbers:                                   Responsible User:

 Group #:                                        Principle Investigator:

 PI Phone:                                PI e-mail:
 Department Affiliation:                  [ ] Engineering [ ] Sciences [ ] Health Sciences [ ] Other
 Reason for Closeout:                     [ ] Leaving University of Utah
 NOTE: Laboratory Closeout Checklist      [ ] Changing locations within the University of Utah
 attached. This checklist must be         [ ] Discontinuing Radioactive Materials Use
 completed to ensure proper closeout.     [ ] Other:
 Hazard Information                       Radioactive [ ] Yes [ ] No            Chemicals [ ] Yes [ ] No
                                          Biohazards [ ] Yes [ ] No             Unknown       [ ] Yes [ ] No
 Equipment to be cleared: List the quantity and type of equipment to be cleared:
   Example: I have a biosafety cabinet and two refrigerators, which held radioactive and biohazardous samples.




 X                                                                                   Date:
 PI Signature (if the lab included use of radiation then Responsible User Signature)


          New Laboratory                         Building Name/Number:
                                                 Lab Manager:
 Room Numbers:                                   Point of Contact:

 Phone:                                          E-mail:
                                                 * If radioactive material will be used in your new lab space, a startup
 Estimated                                       survey will need to be completed before you move radioactive material
 Move In Date:                                   into the new lab.
             Http:/www.ehs.utah.edu                   Http://www.rso.utah.edu/                  L:/forms/LabRelocation.doc

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                                                                                      Laboratory
                                                                                  Closeout Checklist
Clearance Requirements
Investigators vacating University of Utah facilities or relocating within the U of U system are responsible for leaving laboratories
in a state suitable for re-occupancy or renovation. The following clearance checklist is to be completed by the laboratory and
each applicable item initialed upon completion.
                                                                                                                            Completion
                                                                                                                           Date and initial
As soon as possible and at least 30 days prior to move:
      Review your lab’s inventory to be sure all unknown materials have been identified.
      Segregate all hazardous materials into appropriate categories and properly tag all hazardous materials
      containers. (If you have mixed waste, be sure to completely describe all contents.)
      Schedule hazardous materials pickup.
General Housekeeping
      Remove broken glassware and non-contaminated sharps in rigid, puncture-resistant containers.
      Remove and properly discard or store old books and other personal property.
Radioactive Materials
      Ensure that all radioisotope disposition forms (RPR 13C) are completed for all disposed isotopes.
      Complete transfers of radioactive materials to another responsible user as desired. (Transferring of
      radioactive material between users is outlined in RPR 13 “Isotope Acquisition & Disposition.” The RSO
      must approve all transfers or shipments.)
      Thoroughly survey your lab space and equipment for radioactive contamination. Perform both direct and
      wipe surveys. Be sure to include areas and equipment, even those believed to be “clean”, to ensure that
      radioactive material has not been spread to unexpected areas.
           Clean any areas that indicate elevated levels of radiation
           If elevated levels are still present after cleaning, notify your assigned Radiological
               Health analyst of the location of the fixed contamination.
      Contact your Radiological Health Analyst if you wish to surplus any equipment that has a radioactive source
      or generates radiation (i.e. Liquid Scintillation Counters or X-ray machines). Do not abandon equipment!!!
      Transfer it or surplus it.
      Transfer of surplus radiation detecting equipment. Inform the Radiological Health Department of the
      destination of your instruments
      Inform the Radiological Health Department of the status of your personnel. (Transferring to a new RU or
      terminating employment)
      Return dosimeters to the Radiological Health Department and fill out a RPR 1C “User Termination Check
      List” for each person leaving the university.
Biohazardous Materials
      Disinfect all work surfaces, refrigerators, freezers, and equipment (e.g. centrifuge).
      Deface biohazard symbol from bags/containers of all previously disinfected materials.
      Coordinate with EHS to dispose of all infectious waste. Ensure infectious sharps container is not
      overflowing.
      Remove all media and supplies from drawers, shelves, and cabinets.
      Decontaminate biosafety cabinet prior to moving and ensure re-certification after move.
Chemical Safety
      Label peroxide compounds with the last date opened.
      Immerse water and air reactives in appropriate solutions.
      Remove all empty bottles and cans. The containers should be empty, the label defaced, the cap removed
      before placing in the regular trash.
      Wash laboratory bench tops with soap and water.
      Remove all debris from the fume hoods.
      Wipe down fume hood surfaces with Alconox or equivalent.
      Run water into all sinks and floor drains to fill traps.
After moving, revisit your old lab space. Have any materials been left? Have any hazardous
materials been left in your old lab? Have all radioactive stickers and labels been removed? (Note:
Only remove radioactive labels from areas that you have posted and are no longer radioactive. The
room postings posted by the Radiological Health Department will be removed when the room is
officially cleared by the Radiological Health Department.)
Note: You are responsible for your lab and all materials in your lab until the Radiological
Health and Environmental Health and Safety Departments officially clear your lab.
              Http:/www.ehs.utah.edu                  Http://www.rso.utah.edu/                L:/forms/LabRelocation.doc

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