DISPOSAL OF REFRIGERATORS
For the disposal of any refrigerator on campus, first you must complete this refrigerator disposal form and
have it signed by an EOHS member. If this form is not signed, your refrigerator will not be picked up.
Attach this form to one work order for Special Services (moving the unit). A second work order is needed
for HVAC (refrigerant recovery).
Department
Building
Room No.
Contact Person Name:
Telephone:
Type of Refrigerator:
Prior Use:
Chest
Upright
Full Size Domestic
Explosion Proof
Chemical
Is the unit currently in use?
Food Products
Yes
Other
No
FOR EOHS USE ONLY
Unit has been inspected based on the information
supplied:
Unit is ready to be moved:
Name:
Yes
No
Date:
FOR PFOC USE ONLY
Work order to move refrigerator for disposal:
Date:
FOR HVAC USE ONLY
Work order for refrigerant recovery:
Date:
This form is available on our website at http://www.healthandsafety.uakron.edu.