FiltraCheck™ Form

NAME:
COMPANY:
ADDRESS:
CONTACT NUMBER:
Type of Fume Hood*: þ Ducted Fume Hood  Ductless Fume Hood
*Note: Please choose your preference. The correct Fume Hood type will be recommended based on the application and chemical information provided below.
CHEMICALS APPLICATION
Frequency of Work
Type of work Quantity of
Open or covered Temperature of Per Day (PD) Duration of handling
No. Name Concentration (%) (e.g. Distillation, chemical used
handling (°C) Per Week (PW) (mins, hours)
Transfer etc.) (mL, L, or g)
Per Month (PM)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
ADDITIONAL REQUIREMENTS
Are you going to place any apparatus inside the fume hood? What are your requirements for Accessories / Service Fixtures? (May vary
þ Yes, please specify: ___Retort Stand, heating mantle, beaker, hot depending on the recommended fume hood model type)
plate_______________________________________________ þ Faucet þ Sink/ Drip Cup* SF- Gas SF- Water
____________________________________________________________________ þOthers, please specify: electrical socket
 No

GLOBAL HEADQUARTERS
 Singapore, Indonesia, Philippines
GLOBAL OFFICES
ASEAN: Malaysia,  Thailand,  Vietnam  |  FAR EAST: China,  Hong Kong, Taiwan,  South Korea,  Japan | SOUTHASIA:  Bangladesh,  India  |  MIDDLE EAST: UAE  
 AFRICA: South Africa  | NORTH AMERICA: USA  | EUROPE: United Kingdom, Italy, Denmark,  Lithuania,  Russia
 FiltraCheck™ Form
REMARKS (If applicable)

FiltraCheck™ Form Informative Notes

Chemicals

 Name: The name of the chemical used in the fume cabinet (e.g. Toluene). For trade name, please provide material safety data sheet.
 Concentration: Indicate the concentration of the chemical (in % volume for fluids and % mass for solids).

Application

 Type of Work: Provide method used, technique or other details on the nature of the work / process being carried out (e.g. Distillation, Transfer etc).
 Open/Covered: Mention whether the process is being carried out open or covered.
 Temperature: The temperature at which the work / process is being carried out. This is especially important in case the process requires the chemical to be heated.
 Frequency: Specify how frequently the concerned work / process is carried out (e.g. 2xPD, 1xPW).
 Quantity: Quantity of chemical (in ml. or gm.) used during the process.
 Duration: Time taken for carrying out the process.

Kindly provide as much information as possible for us to be able to make an accurate assessment. Please complete the form and we will revert back to you
after completing the assessment.

GLOBAL HEADQUARTERS
 Singapore, Indonesia, Philippines
GLOBAL OFFICES
ASEAN: Malaysia,  Thailand,  Vietnam  |  FAR EAST: China,  Hong Kong, Taiwan,  South Korea,  Japan | SOUTHASIA:  Bangladesh,  India  |  MIDDLE EAST: UAE  
 AFRICA: South Africa  | NORTH AMERICA: USA  | EUROPE: United Kingdom, Italy, Denmark,  Lithuania,  Russia