PI Onboarding / Relocating Checklist (Hazards and Lab Needs) FP&M & OEHS

This form is used by incoming faculty to initiate contact with Facilities, Planning and Maintenace and to identify the type of laboratory required, and hazards involved, in order to work safely and comply with regulations.

Fields with asterisks (*) are required.

Requester Information

First name *

Last name *

Email *

Contact number

Researcher's current location information

Address line 1 *

Address line 2

City *

State/province/region *

Postal/zip code *

Country *

Email *

Contact number

When does your WSU employment start?

Researcher's Wayne State location information

School / College / Division

Department

Department contact name / phone / email

Office: Building and room no.

Office phone

Lab: Building and room no.

Lab phone

Lab / Office Infrastructure

Will your office or lab require renovations? *

yes

Is the lab currently occupied? *

Other special need / use *

Specialized Equipment

Specialty Water (RO,DI,etc.)

Audio / Video Equipment

Special Accessibility Needs (ADA)

Photo Development Equipment

Secondary Support Space (Tissue Culture, Microscopy...)

Lab Certification (Radiation,Chemicals, etc)

None of the above

Other (specify)

Type of Research

"Dry Lab"

Cognitive

Computer

Observation

Other. Please describe below.

Other (specify)

*Indicate if your research involves "Wet Lab" with any of the following (If not sure, please indicate your timeline in the customer-provided narrative summary below):

2. Will you work with infectious agents (including viral vector rDNA), select agents or toxins? Please see: Biohazard Information *

Yes

Do you have any samples of infectious Poliovirus or Poliovirus potentially infectious materials? *

Infectious Poliovirus Materials

Poliovirus potentially infectious materials (PIM)

None of the above

Poliovirus PIM includes human fecal samples and upper respiratory secretions collected for polio or non-polio related work in a time and place where one of the following apply:
1. Wild Poliovirus (WPV) was circulating
2. Vaccine derived poliovirus (VDPV) was circulating
3. Oral polio vaccine was in use.
Please see: Poliovirus Eradication Initiative

3. Will you work with any radioactive material or use radiation emitting equipment? Please see: Ionizing Radiation Use Information *

Yes

4. Will you work with vertebrate animals? Please see:Institutional Animal Care and Use Committee Information *

Yes (please indicate species below)

5. Will you generate chemotherapy waste? Note: In Michigan, all chemotherapy waste must be managed as hazardous chemical waste.

Yes

6. Will you work with Class 3b or 4 Lasers? Please see: Laser Safety Information *

Yes

7. Will you work with Controlled Substances? Please see : Controlled Substances Program *

Yes

8. Do you plan to ship Dangerous Goods (Hazardous Materials,including dry ice)? Please see : Dangerous Goods Shipment Information *

Yes

If yes, please describe below

9. Do you work with combustible metals, or combustible metal compounds? *

Yes

If yes, do you have access to a Class D fire extinguisher?

Yes

10. Do you work with flammable materials that need to be refrigerated? *

Yes

If yes, do you have access to a flammable rated refrigerator?

Yes

Customer-provided narrative:

Do you have any additional information to share with OEHS/FP&M that is not captured above? *