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Use this worksheet to summarize: (a) lab coat type(s) requested, (b) size(s) needed, and (c) embroidery details (optional) prior to purchase.
Complete all fields below.
NOTE
: Worksheet data will be sent to Requestor, Department Purchaser, and Lab Safety upon submittal.
Requestor
Requestor Email
Phone (mobile or office)
PI
Department
Lab Bldg/Rm
Department Purchaser
Department Purchaser Email
Lab Hazard Assessment Tool (LHAT) Verification
I
DO NOT
have a Risk & Safety Solution Account (RSS).
I have a Risk & Safety Solution Account (RSS).
Please upload a recently completed
LHAT
. For information on Risk & Safety Solutions, visit the
RSS
web page.
Questions?
Contact
Lab Safety
.
Drop files or click here to upload
Please enter LHAT Certified Date and Expiration Date into the respective fields below. Log into
RSS
to update your LHAT and obtain these dates.
Questions?
Contact
Lab Safety
.
LHAT
Certified Date
LHAT
Expiration Date
Select lab coat type(s). Refer to the
PPE Selection
web page for information on selecting proper PPE.
Nomex - CP Chemical Splash
Nomex I
Nomex II
FR Treated Cotton
Standard Cotton 100%
Fluid Resistant (barrier)
Nomex CP Chemical Splash (royal blue) - snap front, elastic cuffs - Enter quantity needed.
2XSmall
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Total
Nomex I (royal blue) - snap front, elastic cuffs - Enter quantity needed.
2XSmall
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Total
Nomex II - snap front, snaps on cuffs - Enter quantity needed.
2XSmall
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Total
Flame Resistant Treated Cotton - snap front, snaps on cuffs - Enter quantity needed.
2XSmall
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Total
Standard Cotton 100% - button front, no cuffs - Enter quantity needed.
2XSmall
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Total
Fluid Resistant, 100% polyester (white) - snap front, elastic cuffs - Enter quantity needed.
2XSmall
XSmall
Small
Medium
Large
XLarge
2XLarge
3XLarge
Total
Embroidery (
optional
)
Yes
No
Enter details for embroidery here. If a Heat Seal Patch is preferred, upload artwork below.
Enter details for embroidery here. If a Heat Seal Patch is preferred, upload artwork below.
Size & Qty
Embroidery Line 1
Embroidery Line 2
Embroidery Line 3
Enter size
Qty
Name of person or department
Logo
Name of department
Nomex CP
Nomex I
Nomex II
FR Treated Cotton
Standard Cotton
Fluid Resistant
Upload supporting documents here (
e.g., logo, artwork for heat seal patch
)
Drop files or click here to upload
Notes/Instructions
(
e.g., Script font in gold for Embroidery Line 1
)
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