Rutgers Environmental Health and Safety
REHS Home
REHS Shipment Request Form
Shipper Information
Name
Department/Lab
Street Address
Phone
E-Mail
Destination Information
Name
Company/University
Phone
Address Line #1
Address Line #2
Country
City
State/Providence
Zip Code
Materials Being Shipped
Yes
No
Chemical
Radioactive
Biological
Genetically Modified
Dry Ice
Cold Pack
Additional Information for Chemical Shipment
Name of Chemical/Product
(no formulas or
acronyms)
Number of
Containers
Amount of Material
in each container
(mg, kg, mL, L, etc)
Physical State
Estimated Value ($)
#1
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
#2
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
#3
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
#4
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
#5
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
#6
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
#7
Solid
Liquid
Gas
Plasma
Bose-Einstein condensate
[add another row]
Additional Information for Radioactive Shipment
Isotope
Activity
Please specify µCi or mCi
in your response for activity
Additional Information for Biological Shipment
Is the substance infectious?
Yes
No
What is the Pathogen name
Check all that apply
human DNA
human cells
human serum
human tissue
animal DNA
animal cells
animal serum
animal tissue
Other (Describe in Comments)
Additional Information for Genetically Modified Shipment
Has the genetic material of this organism been purposely altered through genetic engineering in a way that does not occur naturally?
Yes
No
Additional Information for Dry Ice Shipment
Amount of Dry Ice (kg)
Comments
