Boston University
Office of Environmental Health and Safety
Charles River Campus:
704 Commonwealth Ave, 2nd Floor
Ph: 617-353-4094; Fax: 617-353-5646
Medical Campus:
715 Albany Street, M-470
Ph: 617 638-8830; Fax: 617 638-8822
Laboratory Pre-Design Questionnaire
Please answer the following questions to the best of your ability. Accurate answers to these
questions will help ensure that your laboratory complies with applicable federal, state and local
regulations, and will help ensure the safety and well-being of individuals in this lab space.
Failure to accurately answer the following questions may adversely affect the design of your
laboratory.
Completed forms should be sent to the Office of Environmental Health and Safety.
Principal Investigator:
Contact Phone #:
E-mail:
Alternate Contact Phone #:
Laboratory Name:
Address:
Lab Room Number(s):
Department:
Please outline the nature of your research:
A) Chemical Use
1) Complete the attached Hazardous Materials Survey. Please provide a complete inventory
of chemicals that will be used in this laboratory. Please include the concentration of
each chemical in addition to the quantity.
Please attach the complete inventory to this checklist, and return to OEHS at the address
listed in the header.
Note: chemicals that may be used in the future should be noted on this inventory as
“possible future use”.
2) Will any liquid-form silanes be used? Yes
1
No
Boston University
Office of Environmental Health and Safety
Charles River Campus:
704 Commonwealth Ave, 2nd Floor
Ph: 617-353-4094; Fax: 617-353-5646
Medical Campus:
715 Albany Street, M-470
Ph: 617 638-8830; Fax: 617 638-8822
3) Will this lab be using chemicals that were formerly used in another laboratory?
Yes
No
If so, please contact Michael Penn, Research Safety Manager, at (617) 353-4094. Please
note that no organic peroxides may be transferred from another laboratory.
4) Will any highly toxic chemicals, be used? Yes
No
Please review the Hazardous Materials Survey and indicate all that apply.
5) If using any highly toxic chemicals, have less toxic materials been considered?
Yes
No
B) Submit a list of all laboratory equipment using the attached Equipment Inventory List.
Include equipment such as: Chemical Fume Hoods, Bio-Safety Cabinets, Laminar Flow
Hoods, Refrigerators, Freezers, Ovens, Machinery, etc.
C) Will animals be used in this laboratory? Yes
No
D) Will Bio-Hazardous Materials be used or generated? Yes
No
If yes, contact Michael Penn, Research Safety Manager, at (617) 353-4094.
E) Will any human-source material (including cell lines and rDNA) be used? Yes
If yes, contact Michael Penn, Research Safety Manager, at (617) 353-4094.
No
F) Will any select agents be used? Yes
No
If yes, contact Rebecca Caruso, Biosafety Manager, at (617) 638-8842.
G) Will lasers be used in this lab? Yes
No
If yes, contact If yes, contact Radiation Protection at (617) 638-7502.
Also, please indicate the quantity of lasers for each laser class (indicate all that apply)
Class 1
Class 2
Class 3a
Class 3b
Class 4
H) Will X-Ray generating devices be used in this lab?
Yes
If yes, contact Radiation Protection at (617) 638-7052.
2
No
Boston University
Office of Environmental Health and Safety
Charles River Campus:
704 Commonwealth Ave, 2nd Floor
Ph: 617-353-4094; Fax: 617-353-5646
Medical Campus:
715 Albany Street, M-470
Ph: 617 638-8830; Fax: 617 638-8822
I) Will any controlled substances be used in this lab?
Yes
No
If yes, contact George Bain at (617) 638-4965.
J) Will any radio-nuclides be used in this lab?
Yes
If yes, contact Radiation Protection at (617) 638-7502.
No
Also, check which radio-nuclides will be used:
32
35
14
3
125
P
S
C
H
I
Other (please specify):
K) Will any compressed gases be used in this laboratory? Yes
No
Please review the Hazardous Materials Survey and indicate all that apply.
L) Will any of the following gases be used?
Yes
No
(Please check all that apply):
Arsine
Chlorine
Hydrogen chloride
Hydrogen peroxide
Phosphine
Boron tribromide
Fluorine
Hydrogen cyanide
Methylamine
Silicon Tetrachloride
Boron trifluoride
Hydrogen bromide
Hydrogen fluoride
Ozone
M) Will any cryogenic gases be used in this laboratory?
Yes
Bromine
Phosgene
No
Please review the Hazardous Materials Survey and indicate all that apply.
N) Will there be a cold room in this laboratory?
3
Yes
No