750 Main_Facilities Change Form

The purpose of this form is to outline the facilities change requests necessary for your project. Your submission will be reviewed by The Engine’s Facilities, Lab Operations, Engineering, and Environmental Health & Safety (FLOpES) teams, which meet weekly on Thursdays to review requests. Please ensure all information is complete, accurate, and based on your best knowledge. Incomplete or missing details may result in delays to your project’s approval and execution.

Please complete all applicable sections of this form. Any sections that do not apply can be left blank.

Contact Information

Company Name*

Requester Name*

Requester Email*

Location of Proposed Change*

Project Overview

Please provide a detailed summary of the facilities changes that you would like to make. Be as descriptive as possible. *

Infrastructure Overview

Provide an overview of the infrastructure changes required for your work. Please include all relevant considerations for review.

Any missing information may result in a delay in your project’s approval and completion.

Reset Policy

All modifications to 750/730 Main or 501 Mass Ave will be overseen by the Facilities Department. Once approved, a scope of work and associated costs will be provided. By agreeing to the modifications, you accept responsibility for restoring the space to its original condition upon lease termination.

I have read and understand the Reset Policy*

PLEASE INITIAL

Please select all applicable infrastructure changes that are required. *

	Select if Yes	Specifications (e.g. Voltage, Amperage, CFM requirements, etc.)
Exhaust/HVAC change
Plumbing
Electrical >120V, 20A
Other (e.g. Compressed Gases)

If you answered Yes to any of the above, attach an equipment cut sheet and any other relevant documentation*

Electrical Safety

Per our Master Lease with MIT, all equipment must be certified through a Nationally Recognized Testing Laboratory (NRLT). NRLTs are private-sector organizations that OSHA has recognized as meeting the legal requirements in 29 CFR 1910.7 to perform testing and certification of products using consensus based test standards.

NRLTs List

It is the responsibility of residents to confirm that any equipment that they are purchasing or bringing on site meets the standards set by OSHA. For custom or prototyped equipment that has not been certified, The Engine works with a 3rd party to do a field assessment, which will be billed to the resident company.

Is your equipment certified through one of the above listed NRLTs?*

If you have selected no, please reach out to labs@engine.xyz

Please provide a copy of the Certificate of Conformance or other documentation to confirm. *

Electrical Guidelines

The Engine's general guideline for new electrical circuits within the lab areas are as follows:

Engine's standard lab bench at 750 Main 40A of 110V equal to 4400W.
Engine allows residents to request up to another additional 4400W in 110V-230V.

If renting space in a shared lab, please note the number of benches rented to determine electrical allowance:

Please list all materials being used with regard to this form/project *

	Select if Yes	Material(s)	Quantity
Hazardous Chemicals*
Biological Hazards*
Physical Hazards
Compressed Gases
Other

*If you have selected "Yes" to either Biological Hazards or Hazardous Chemicals, and you are planning to begin working with new biologicals and/or chemicals that the Lab Operations Team is unaware of you must also submit a Biological Amendment and/or Chemical Amendment so that we can asses and keep record of this new workflow.

Please add a process description/intended use of the equipment and hazards listed above (including where the intended work will be performed PLEASE BE SPECIFIC)

Please attach any Safety Data Sheets (SDS) for all hazardous material*

Environmental Health and Safety

Please provide a description of the safety protocols that will be in place, as necessary

Pallet Removal Policy

Pallets, crates, and other packing materials must be removed immediately from your laboratory space. Items can be placed in the loading dock pallet removal area for off-site disposal. Your company will be billed for the removal of crates or pallets, based on size and weight.

I have read and understand the Pallet Removal Policy*

PLEASE INITIAL

Certification and Signature

I understand that acceptance of this Request Form, as written, does not constitute a requirement for The Engine Accelerator to accept or approve any additional work at any Engine operated facilities.

Requester Signature*

Date*

Date