Biotron Online Application
UNIVERSITY OF WISCONSIN
BIOTRON
MADISON, WISCONSIN

APPLICATION FOR THE USE OF BIOTRON SPACE AND FACILITIES

  1. INVESTIGATOR(S):
    a. Name:
    b. Email:
    c. Department:
    d. Office Address:
    e. Office Phone:

  2. TITLE OF PROJECT:

  3. RESEARCH REQUIREMENTS:
    (A brief description of the project protocol including the amount of space required, and environmental conditions such as temperature, humidity, light level, day length, and CO2 concentration.)

  4. TIME:
    (How much time will you need, and when would you like to start?)

  5. BIOHAZARDS:
    (Indicate all biological hazards to people or other organisms in the building, including microbiological and recombiant organisms, insects, volatile chemicals, toxic chemicals, radioactive isotopes, drugs, etc. Attach copies of any forms required by UW research review commities.)

    Checklist of Attached Forms
    Biological Safety OBS-2-(1991)
    Recombinant DNA OBS 11-(1991)
    Radiation Materials Safety Form 99
    Animal Use Protocol RARC 01/91
    Animal Source and Health Status Documentation
    Human Subjects
    Other:

  6. BILLING INFORMATION:
    Either an active internal requisition or Fund, Account, & UDDS are required before the actual start of the project.)

  7. PEOPLE TO BE CALLED:
    List names in order of priority for contact in the event of an emergency or discrepancy in the environmental conditions.)
      Name Office Address Office Phone # Home Phone #
    1:
    2:
    3:
    4:


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