EHSA Authorization Form

This form is to be used when a PI would like to grant a lab manager or other personnel access to EHSA to order radioactive materials, submit waste requests, etc. This form grants the person the same exact access to EHSA as the PI has.

*Note: To have access to EHSA you must be a trained radiation worker, meaning you have completed Radiation Safety 101 (part I and part II).

EHSA Authorization Form

Information for Person Requiring Access
Name:*
First Last
NetID:*
Email:*
PI Information
PI Name:*
First Last
PI Email:*
Information of Person Making Request
Requester Name:*
First Last
Email
This field is for validation purposes and should be left unchanged.

EHSA Authorization Form

Information for Person Requiring Access

PI Information

Information of Person Making Request