SLAC NATIONAL ACCELERATOR LABORATORY • 2575 SAND HILL ROAD • MENLO PARK • CAlifornia • 94025 • USA

SLAC is operated by Stanford University for the U.S. Department of Energy

Science Directorate Laboratory Check-in Form

To ensure your safety and the safety of your coworkers, you need to complete the necessary training and become familiar with the hazards of a particular area before performing work. The Science Safety website contains additional safety information as well as a detailed training plan. Please fill in the form below indicating the type of work you will perform and the research areas where you need access.

Contact Information:

Last Name: / First Name: / MI:
Phone Number: / Email:
Brief description of work:

Supervisor or designee/ Point of Contact:

Name: / Signature:

Please Check All That Apply:

Postdoc / Grad Student
PI / Staff / Other:
Visitor / Visitor requesting SLAC Badge
STA Updated (Lab Owner or designee/ESH Coordinator): / Signatures / Date:
Keys /Key Card access issued (Bldg Mgr/): / Signature / Date

Note: For PULSE and SUNCAT the Lab Owner must sign this form to grant access

For SIMES, the Assistant Director or Lab Owner can sign off to grant access

*See page 2 for a list of labs and owners

Check Areas Where Unescorted access is needed (reference training matrix by going to Science Directorate Infrastructure and Safety Website. Go to >Training, Access, and Safety>Required Training to see Training Matrix by Lab)

Lab name and number / Lab Owner / Signature Releasing Access and date (Lab Owner or designee – someone who understands laboratory activities)
Wolf Lab 101, 102 / Thomas Wolf
Bucksbaum Laser Labs 131/132 / Phil Bucksbaum
Bio Labs 103-106/117 / Phil Bucksbaum
Gaffney Labs 127,128,130 / Amy Hahn
Heinz Labs 146 / Tony Heinz
Lindenberg Laser Labs 206, 207 / Aaron Lindenberg
Reis Laser Labs 203-205 / David Reis
Catalysis Lab 119/120 / Thomas Jaramillo
SUNCAT Wet Lab 118 / Thomas Jaramillo
Smart Grid Lab (B27) / Sila Kiliccote
SIMES Energy Storage Lab – 232 / Yi Cui/Rob Moore
SIMES Synthesis Lab – 236, SEM and AFM / Nick Melosh/Rob Moore
SIMES Laser/MBE lab - 237 / Harold Hwang/Rob Moore
SIMES Measurement Lab – 231 / Ian Fisher/Rob Moore
SIMES UHV Lab – 230 / Patrick Kirchmann/Rob Moore / `
S10 Lab / Siegfried Glenzer
LZ test stand (620) / Daniel Akerib

SLAC NATIONAL ACCELERATOR LABORATORY • 2575 SAND HILL ROAD • MENLO PARK • CAlifornia • 94025 • USA

SLAC is operated by Stanford University for the U.S. Department of Energy