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ChemBio Services Facility - Request form
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Institution
*
Your answer
Department / Group*
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Your answer
Function*
*
Your answer
Type of service
*
Equipment: Access for experienced users
Sample Measurement
Data analysis support
Other:
Facility & Equipment
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AFM: Atomic Force Microscopy
BSL-2: Cell culture laboratory
BSL-2: Flow cytometry
Required
Type of request
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Very urgent (within the next 5 business days)
Urgent (within the next 10 business days)
Less urgent (within the next 15 business days)
Non-urgent
Purpose of the analyses
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Your answer
Starting date (preferred expected date for starting the analysis)
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MM
/
DD
/
YYYY
Final date (predicted) or defined deadline
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MM
/
DD
/
YYYY
Expected regularity
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One time request
Trial experience (there may be continuity in the analysis)
Short term user (expected required access for a period up to 3 months)
Frequent user (intention to periodically use this equipment for a period up to 12 months)
Long term user (expected required access for a period longer than 1 year)
Know the chemical/biological risks associated with the work execution?
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Yes
No
Know the general safety rules (namely familiarization with emergency procedures and contacts, identification of respective risk locations and means of first intervention)?
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Yes
No
Know the specific safety rules associated with the work to be performed
*
Yes
No
Phone number
Your answer
Comments
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