Permit Request • CampusOptics

To begin the process, we ask that you please complete the following Pre-Commissioning Consultation Form as soon as possible after assignment of laboratory space and prior to conducting research. This form will help us determine the types of hazards you may be working with and assign appropriate staff to assist you. After receiving your submittal, EHS will schedule a consulting visit to discuss university policies, safety guidelines and training requirements related to your research. You may contact us at 870-972-3644 or 870-972-2862 or email mdooley@astate.edu for questions or additional information.

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

General Questions

Dean/Chair/Director Name* Required

Dean/Chair/Director Email* Required

Department* Required

Chemical Risks

Using/storing hazardous chemicals such as flammables, combustibles, corrosives, oxidizers, carcinogens, reproductive toxins, cryogenic liquids, etc.?* Required

Using or synthesizing nanoparticles?* Required

Biological Risks

Working with recombinant materials or biological agents (rDNA, viral vectors, bacteria, viruses, protozoa, parasite, prion, rickettsia, etc.), biological toxins, or human or non-human primate blood, cells or tissues?* Required

Working with research animals?* Required

Administering rDNA, infectious agents or hazardous chemicals (including FDA approved or experimental pharmaceutical products, laboratory chemicals and inhalation anesthetics) to live animals?* Required

Radiation / Lasers

Working with ionizing radioactive materials, radioactive sealed sources/equipment with sealed sources, or any radiation-producing devices, such as, an x-ray machine, neutron generator, etc.?* Required

Working with Class IIIB or Class IV Lasers?* Required

Working with other non-ionizing radiation, such as UV, IR, or microwaves?* Required

DEA Controlled Substances

Do you plan to possess/use controlled substances that are regulated by the Drug Enforcement Agency (DEA)?* Required

Do you have any other safety or environmental concerns or questions to discuss during our visit?* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files

Requester

Permit Date & Time

Location

General Questions

Chemical Risks More information

Biological Risks More information

Radiation / Lasers More information

DEA Controlled Substances More information

Add Supporting Documents

Chemical Risks

Biological Risks

Radiation / Lasers

DEA Controlled Substances