Emergency Shower and Eyewash Request for EH&S Support

Please complete this form to request financial support for the installation of emergency showers and/or eyewash stations in UCLA research laboratories.

To complete this request, you will need to know:

The type of equipment to be installed
The location(s) of the installation
The FSR number for your written estimate from Facilities Management.

Requests will be reviewed in the order they are received while funds are available.

Does your project involve installation of an eyewash station?

Yes

Does your project involve installation of an emergency shower?

Yes

Does your project involve removal of any existing eyewash or emergency shower?

Yes

Please provide a brief rationale for the planned removal of existing life safety equipment

Please list the building(s) and room(s) where the equipment will be installed

How much financial support are you requesting?

Please provide the FSR number for the written estimate for this project.

Please provide the name of the primary contact for this request.

Please provide the email address of the primary contact for this request.

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