Addendum B
Pre-Approval Form for Requisitions with Hazardous Items or Vehicles
Requester’s Name: _____________________________ and email
Note: Requester must be Principle Investigator or faculty member for teaching laboratories in cases of purchases
requiring approval of Environmental Health and Safety.
Requester’s Signature: _______________________________
Date: __________
Requisition Number (attach requisition paperwork): _______________________________
Department Contact for Requisition: ____________________ and email ___________________
Itemization of materials to be purchased (attach additional documentation if needed):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Approvals, as appropriate (Requestor must check applicable category below.):
Department of Environmental Health and Safety: email to ehs@uh.edu
___ Radioactive Materials
Date: __________
___ X-Ray Machines_______________________________
Date: ___________
___ Class 3b and 4 lasers_______________________________
Date: ___________
___ Biological Agents that are either Select Agents/Toxins
or Risk Groups 2 or 3 _____________________________
Date: ___________
___ Biological Safety Cabinets ___________________________ Date: ___________
___ UH Controlled Chemicals (see list below) _______________ Date: ___________
1
Peroxide Forming
Chemicals/ Chemicals
requiring special
handling
Chlorobutadiene
Chlorotrifluoroethylene
Methyl methacrylate
Tetrafluoroethylene
Vinyl acetylene
Vinyl chloride
Vinyl pyridine
Vinylidene chloride
Acetal
+Diacetylene
Divinyl acetylene
Toxic Compressed Gases
Shock Sensitive
Compounds
Acrolein
Acrylyl chloride
Chlorine dioxide
Chlorine trifluoride
Chloropicrin
Cyanogen chloride
Cyanuric fluoride
Decaborane
Dichloro acetylene
Dimethylsulfide
Ethylene chlorohydrin
Arsenic pentafluoride
Arsine
Bromine pentafluoride
Carbonyl fluoride
Carbonyl sulfide
Chlorine dioxide
Chlorine pentafluoride
Chlorine trifluoride
Cyanogens
Cyanogen chloride
Diborane
Alkyl nitrates
Alkyl perchlorates
Diazo compounds
Dry diazonium salts
Metallic azides
Nitrocellulose
Picric acid, dry
Methyl acetylene
Methyl cyclopentane
Ethylene fluorohydrin
Hexamethylene diisocyante
Dinitrogen tetroxide
Fluorine
Methyl-i-butyl ketone
Tetrahydronaphthalene
Hexamethyl phosphoramide
Iron pentacarbonyl
Germane (GeH4)
Germanium tetrafluride
Vinyl ethers
Isopropyl formate
Hydrogen cyanide
Hydrofluoric acid
Methylacryloxyethyl isocyante
Methylene biphenol isocyante
Methyl fluoroacetate
Methyl fluorosulfate
Hydrogen fluoride
Hydrogen selenide
Hydrogen sulfide
Methyl bromide
Nitrogen tetroxide
Oxygen difluoride
Methyl mercaptan
Monomethylamine
Pentaborane
Perchloromethyl mercaptan
Phosphorus trichloride
Sarin
Sulfur monochloride
Sulfur pentafluoride
Sulfuryl chloride
Tellurium hexafluoride
Tetramethyl succinonitrile
Tetranitromethane
Toluene-2,4-diisocyanate
Trichloro (chlormethyl) silane
Nitrogen dioxide
Phosgene
Phosphine
Phosphorus hexafluoride
Selenium hexafluoride
Silicon tetrafluoride
Stibene (SbH3)
Sulfur tetrafluoride
Sulfuryl fluoride
Tungsten hexafluoride
Vinyl chloride
Any Chemical Purchased
in Quantities in Excess of
40 Gallons
2
Acutely Toxic Chemicals
Highly Hazardous
Chemicals
Aconitine
Bis (chloromethyl) ether
(dichloromethyl)
Amanitin
Diisopropyl
Fluorophospate
Chloromethyl ether
methyl
Microcystin
Soman
Tabun
Chemicals Containing
Radioactive Materials
Uranium
Thorium
Department of Facilities Management: email to nsmith@central.uh.edu
___ Vehicles (MAPP 03.01.04)
Date: __________
Routing Instructions for Addendum B
1.
The completed Addendum B, purchase requisition, and related paperwork (vendor quote,
etc.) must be scanned and emailed to ehs@uh.edu for Environmental Health & Safety
approval or to nsmith@central.uh.edu for Facilities Management approval.
2.
Once the Addendum B is approved (signed) by Environmental Health and Safety or
Facilities Management, the Addendum B will be scanned and emailed to the Requestor
and the Department Contact noted above.
3.
The Department Contact will attach the approved Addendum B to the requisition in the
Finance System and send it to Purchasing through electronic workflow.
3