Emergency Shower and Eyewash Request Form
* for University of Georgia use only

 

Emergency shower and eyewash stations are important pieces of emergency equipment that must be properly maintained.  If you are having problems with your emergency shower or eyewash station or feel your work area is in need of this type of equipment, please fill out the online form below.  If you have any questions, please feel free to contact Heath Hardison by phone at (706) 583-0329 or e-mail at hhardison@esd.uga.edu.

 
P.I. / Supervisor Name
P.I. / Supervisor E-Mail Address
P.I. / Supervisor Phone Number
   
Department
Building
Room/Laboratory Numbers
Zip + Four Code
 
Please complete if different from above:
Name
E-mail Address
Phone Number
   
Is this a new laboratory? No    Yes
Is the laboratory undergoing a renovation?  No    Yes
Laboratory / work area needs an emergency shower? No    Yes
Laboratory / work area needs an emergency eyewash? No    Yes
Does the laboratory / work area use hazardous chemicals? No    Yes
Does the laboratory / work area use radioactive materials? No    Yes
Does the laboratory / work area use biological materials? No    Yes

Please indicate in the comments box below any maintenance problems you are having with your emergency shower and eyewash stations.

Additional Comments:

              

 

 

 
 
University of Georgia