Sample Intake Form

To avoid delays, complete and return this form before your samples arrive. The identification of hazardous materials in Section 2 and submission of their respective SDS documents are required

Please note that samples will be entered into queue only after a PO for the full quoted amount is received

Analysis or Case number (if provided)

Hazardous Materials Identification

We are unable to accept samples until this section is completed and returned to JH. This includes the explicit written identification of all potentially hazardous constituents along with a complete and current copy of each hazardous constituent’s SDS. Additional information may be requested.

Mark ‘Yes’ or ‘No’ for each category which may apply to any constituent of your sample or packaging. Specify all hazardous materials in the lines at the end of this section.

Please upload all SDS documents using the upload button below the "Outline all hazardous constituents" text box near the end of this section.

Non-hazardous (including fixed and sterile biological samples)?

Yes No

Toxic, carcinogenic, radioactive, inhalation hazard, or irritant?

Yes No

Corrosive, oxidizer, unstable/explosive, flammable/combustible, or incompatible with air or water?

Yes No

Outline all hazardous constituents below

Outline any relevant non-hazardous constituents below

Sample Sensitivities

To protect the integrity of your samples, let us know if they are sensitive to any of the following

Temperatures between 15°C/60°F and 120°C/250°F?

Yes No

Common laboratory solvents (isopropanol, acetone, etc.)?

Yes No

Water or air?

Yes No

Other materials or conditions typical of a lab environment?

Yes No

If you answered ‘Yes’ to any of the questions above, please outline the conditional limitations of your samples

Sample Disposition

Samples which have not been returned or retrieved within 60 days of project completion will be destroyed and disposed of at our earliest convenience. If you anticipate needing these samples for additional JH Analytical services beyond this 60-day window, please let us know.

Upon completion of your project, how would you like your samples handled?

In-person pick up Return shipment (provide information below) Destroy and dispose

For return shipment, please provide the following information:

UPS or FedEx Account Number*

*If you are unable to provide a shipping account number, you may email us a shipping label instead.

Return shipping Address

Recipients name (attention to)