Hospital or Campus:
Center or Department:
Principal Investigator:		Job Title:
Phone Number:
Building:		Room Number:
Emergency Contact and Phone Number:
Total # of fume hoods in lab:
Type Of hood (check one)  Conventional Snorkel Auxiliary Hood Glove Box Variable Air Volume Perchloric Acid Walk In Canopy Other
Chemical-EHRS Hood ID#:
Status:	New      Active      Stored
Serial #:
Manufacturer:		Date of Man:
Model:
Riser fan #:
Use Code: Storage Only General Chemistry Radioisotopes Carcinogen or Toxic Chemicals Ductless Radioactive Perchlroic Acid Other
Used for personal protection:   YES   NO Operational:   YES   NO UV Light:   YES   NO Flow Indicator:   YES   NO Caution Sign:   YES   NO Face Velocity Alarm:   YES   NO
Last Inspection date:
Avg. Face Velocity:
Slash Height:
ASHRAE 100 Commissioning Test Date:
Comments: