Application for Access to ASCG Equipment

Application for Access to ASCG Equipment

Application for Access to ASCG Equipment

User

Name / Click here to enter text. /
E-mail address / Click here to enter text. /
Phone number / Click here to enter text. /
Status / Undergraduate / PhD student / Post-doc
Academic / Visitor / Other
Supervisor / Click here to enter text. /
Department/ institution / Click here to enter text. /
Address / Click here to enter text. /

Experimental details

Equipment required
UV-vis spectrometer / Scanning Hall probe / Critical current goniometer
Cryo-BI-Pulse / Electrical resistometry / Variox (4–293 K)
Furnace (293–1500K) / Other:
Environment
Ambient / Liquid nitrogen / Liquid helium
Vacuum / Bottled gas:
Summary of experimental plan
Click here to enter text.
Samples and materials
If an MSDS is available, please attach a copy. If not, please describe the material as fully as possible.
Click here to enter text.
Training and supervision requirements
I am an experienced user of very similar equipment and will require only minimal supervision
I have some experience of similar equipment and will require brief training
I am a new user: I will require training and close supervision
I would like someone else to undertake the work for me

Health and safety

Chemical/fire risk assessment
No hazardous substances (subject to COSHH or DSEAR regulations) will be used
A COSHH/DSEAR assessment is attached
A COSHH/DSEAR assessment will be completed before work begins
Chemical hazards
Tick each category which applies to at least one material:
/ / / / /
Corrosive / Flammable / Explosive / Irritant / Harmful / Toxic
Schedule 1 poison / Carcinogen / Asphyxiant / Nanoparticles
PPE and control measures
Please specify any safety equipment which you expect to necessary, especially if it is customised or non-standard. ASCG risk assessments may impose additional requirements.
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Scheduling and workload

Preferred start date / Click here to enter text. /
Estimated end date / Click here to enter text. /
Estimated number of visits / Click here to enter text. /
Estimated duration of a visit / Click here to enter text. /
Approximate number of samples / Click here to enter text. /

Supervisor authorisation

Financial declaration
No payment is necessary
I agree to pay at the standard daily rate of £135/day
I agree to pay at the negotiated rate specified below:
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Safety training
The user has received standard laboratory safety training and need not take a written safety test
An induction for local safety procedures will always be provided. Training specific to the equipment will be provided based on risk assessment and the experience of the user.
Approval
I have authorised the user to make this application. To the best of my knowledge, all the information on this form is complete and correct.

Signatures

User / Supervisor / Date
Click here to enter a date. /

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