Your name: Click here to enter name

ICN2 group: Click here to enter name

Will you work on a project that already has approval from the CBS-UAB (Comité de Bioseguridad de la UAB)?

yes ☐ no ☐

If answer is yes, please indicate project number: enter project number

Will you work on a project that will need evaluation/approval from the CBS-UAB (i.e. work with GMOs (genetically modified organisms), or human/primate cells, or pathogens of risk group 2 or higher; see document “activities that need approval from CBS-UAB” for more information)?

yes ☐ no ☐

Will you work with biological agents (cell lines, bacteria, viruses, fungi, protozoa, algae)?

yes ☐ no ☐ If answer is yes, please give as much information as possible below:

Type	Name	Strain/Line	Risk level	Obtained from	Location (f.e. -80º)	Description/comments
choose	enter text	enter text	RG	enter text	enter text	enter text
choose	enter text	enter text	RG	enter text	enter text	enter text
choose	enter text	enter text	RG	enter text	enter text	enter text
choose	enter text	enter text	RG	enter text	enter text	enter text

Describe briefly the work you plan to carry out in the biolab!

Click or tap here to enter text.

Which instruments/equipment you may use?

Equipment name	yes	no	maybe
Biological safety cabinet (BSC)	☐	☐	☐
Laminar flow hood (clean bench)	☐	☐	☐
CO2 Incubator	☐	☐	☐
Autoclave	☐	☐	☐
Fridge 4°C	☐	☐	☐
Freezer -21°C	☐	☐	☐
Ultra low freezer -80°C	☐	☐	☐
Water bath	☐	☐	☐
Benchtop microcentrifuge	☐	☐	☐
Inverted Phase Contrast Microscope	☐	☐	☐
Microwave	☐	☐	☐
Patch clamp	☐	☐	☐
Cryogenic tank (vapour phase of nitrogen)	☐	☐	☐

Will you generate chemical hazardous waste that needs special containment/waste management?

yes ☐ no ☐ not sure ☐

If answer is yes, please specify: enter type of chemical