SEAS Facility Modification Form



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Princeton University School of Engineering and Applied Sciences

Facility Modification Form

This form must be completed and submitted for approval of any planned modifications to facility infrastructure including, but not limited to

building exhaust systems
electrical service
domestic and chilled water systems
other research-specific needs arising from the use of lasers, pressure vessels, semiconductors or toxic gases

Any new connections or modification must be formally reviewed by the SEAS Facilities Manager to ensure that the proposed changes meet building codes and safety standards. This review may take up to two weeks, depending on whether the Facilities Manager needs to consult with other in-house experts.

The SEAS Facilities Manager will issue an approval at the conclusion of the review. No new connections or modifications may begin until the researcher receives the formal approval.

Name

Department

Lab/Group

Phone E-Mail

Dates or Duration of Planned Research

Has the Principal Investigator reviewed and approved the plans?
Yes No

Briefly describe the planned research

Briefly describe the area(s)/systems(s) requiring modification:

Which of the following will the research operation/equipment use? Check all that apply and provide specific information.

Hazardous/toxic substances

(NOTE: For highly toxic chemicals, carcinogens or reproductive toxins, a Particularly Hazardous Substance Use Approval Form must be completed and approved by the Principal Investigator and/or Departmental Chemical Hygiene Officer).

Cryogenic Gases

Flammable liquid storage exceeding 10 gallons

Materials capable of deflagration or detonation

Class IIIb or IV laser

Pressure/Vacuum Vessels

Mechanical equipment that could result in injury in the event of failure (regardless of likelihood)

Exposed electrical circuits operating at more than 50 volts

Equipment operating at temperatures in excess of 100 degrees Celsius

Briefly describe any other potential hazards associated with the planned work.

Indicate types of facility infrastructure connections or modifications required and describe as appropriate. Check all that apply.

Ventilation (supply or exhaust)

Electrical power

Chilled Water

Utilities (water, air, vacuum, natural gas)

Cryogenic liquids (nitrogen, carbon dioxide)

Sewer

Comments or additional information that should be considered by the reviewer(s):



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