Chemical Import Form


ALL FIELDS MARKED * ARE REQUIRED

Name of person requesting approval*

Contact email*

Date*

Chemical name*

Quantity to be used and stored at the nanoFAB*

Is an MSDS sheet attached to this request?
yesno

How many different MSDS sheets were consulted?* If only one, why?

Is this chemical a teratogen, mutagen, or carcinogen? If so, give details on a separate page.*
TeratogenMutagenCarcinogenN/A

What is the LD50 of this chemical and what was the test animal?*

  • Inhalation:
  • Absorption:
  • Other:

Are there recommended exposure levels? If so, what are they?*
yesno

Are there special handling instructions in the MSDS sheets for this chemical?*
yesno

Does this chemical evaporate?*
yesno

Does this chemical have a flash point? If so, what is it?*
yesno

Please describe your intended usage of this chemical, including the tool(s) where it will be used.*

Are there other issues with this chemical that need to be brought to the attention of the nanoFAB staff?

Please attach the MSDS sheet (*.pdf only)

Please enter the validation string:
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