Lab Coat Request Form

Lab Coat Request Form

Please fully complete the form below to request your lab coat from EHS. Please note that EHS will reach out to you via email when your coat is ready for pick up.

First name*

Last name*

Email*

Lab/PI*

If the lab coat is for using as a TA in a teaching lab, please write "Chem teaching" or "Bio teaching" for the lab/PI.

Department/Institute*

Select

Building and Room Number*

Position*

If the lab coat is for using as a TA in a teaching lab, please choose "teaching assistant" for the position.

Select

Current scope of work*

Please briefly and specifically describe the kind of hazards encountered in your work. Be sure to mention any highly hazardous chemicals you work with.

Are you working with hydrofluoric acid (HF)?*

Yes

Are you working with pyrophoric chemicals?*

If so, please list them below.

Yes

Please list the pyrophoric materials you are working with (if applicable)

Where will you be handling the pyrophoric material(s) (if applicable)?

Please choose all locations where you will be working with pyrophoric materials.

Select

EHS is only providing one lab coat per person. If labs require additional coats beyond that, they are responsible for providing those coats. Science Stores carries some disposable lab coats.

Coat size requested*

Small (Size 30-36)

Medium (Size 38-46)

Large (Size 48-56)

Extra Large (Size 58+)

Will you be returning a coat?*

If you are returning a lab coat please check the pockets for loose items.

Yes

Please indicate how long you will need a lab coat*

All lab coats require a yearly cleaning at minimum. Please exchange your lab coat whenever it gets dirty or something is spilled on it (laundering is free for labs!).

Select or enter value

Your lab coat request must be reviewed and approved by EHS staff. Please wait until you receive the "Your lab coat is ready for pickup at EHS" email before you come to the EHS office to get your coat.

I agree to the following Terms and Conditions:*

In exchange for use of the Lab Coat Program, lab members will agree not to mark or deface the lab coats in any way. Any lab that returns a coat that is damaged, stained or abused beyond repair or cleaning will be charged a total replacement fee. Labs are also responsible for paying the replacement cost for lost coats.

Lab coats will be held for 1 week after the approval date; after that date we cannot guarantee availability.

Yes

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