BRIL After-Hours Approval Form

BRIL After-Hours Approval Form
Please read the BRIL After-Hours Requirements before completing this form. BRIL After-Hours Approval is valid until the end of the following November, and only if all details provided remain accurate. After-hours work should be approved by supervisors prior to submitting this application. Additional approval from UNSW Animal Services will be required when accessing their locations after-hours.
Date of application*

DayMonthYear
Applicant Contact
Name*

First NameLast Name
Work Email*
zID
Mobile*
Supervisor Contact
Name*

First NameLast Name
Email*
zID*
Buddy Contact

The nominated buddy must meet the requirements stated in the BRIL After-Hours Requirements including having swipe card access to areas being accessed by the applicant
Name*

First NameLast Name
Email*
zID*
Mobile*
It is recommended to nominate a secondary buddy for situations where the primary buddy doesn't respond or isn't available
Would you like to nominate a secondary buddy?*

YesNo
Secondary Buddy Contact
Name*

First NameLast Name
Email*
zID*
Mobile*
Is this application to include working over the UNSW year-end break (Christmas shutdown)*

YesNo
Please upload existing After-Hours Approval (eg. HS703)*

Please seek After-Hours Approval from your supervisor/Head of School for working over the UNSW year-end break before completing this form
Cancelof
Do you have a medical condition that could put you at risk whilst working alone?*

YesNo
Please provide details*
Instruments and locations of after-hours work

Please note that you may only use instruments for which you have received training and been granted access
Lowy C25 (Instrument - Room)

X-Rad - B07Laser Speckle - B07Ultrasound - B07Leica Surgical Microscope - B07Inveon PET-CT - B08MI Labs U-CT - B09SpectrumCT - B09Bruker MRI - B17/AOther
WW C27 (Instrument - Room)

EchoMRI - LG19Other
Are there any additional BRIL locations being accessed?*

YesNo
Lowy (C25)

B07B08B09B17B19
Wallace Wurth (C27)

LG19
Have you read and "Declared as Read" all BRIL SWPs and RMFs covering the activities being undertaken? (please consult BRIL staff if you're unsure)*

YesNo
Does the work involve any of the following? (select all that apply)

Risk group 3 or higher biological agentsUse of sharpsAnaestheticsHazardous substances (including substrates, tracers, reagents, cytotoxic drugs or nanoparticles)Any other activity with a medium to high risk rating
Are any additional activities being undertaken that are not included in BRIL's established safety documentation? (please note that significant deviations are subject to BRIL approval)*

YesNo
Please provide SWP, RMF and/or MSDS for any additional procedures, hazardous substances or equipment*

Cancelof
Please nominate an interval for contacting your buddy (aside from the mandatory arrival and departure notification):*

0.5 hours1 hour2 hoursNAOther
Please justify*
Contacts

Please note that as part of this approval you are required to answer lab phones if and when they ring

UNSW Security Emergencies	9385 6666
UNSW Security Enquiries	9385 6000

BRIL Lab Phones
Lowy B07	9385 8191
Lowy B08	9385 8227
Lowy B09	9385 1814
Lowy B17	9385 9108
Wallace Wurth LG19	9385 1069
BRIL Staff Contacts
Tzong-tyng Hung	0410 693 448
Brendan Lee	0435 779 895
Andre Bongers	0451 015 799
Carl Power	0423 516 571

In submitting this application I agree to:
- Comply with the BRIL After-Hours Requirements
- Comply with UNSW HS322 Working Alone or After-Hours Guideline
- Follow all UNSW emergency procedures including instructions in the UNSW Emergency Procedures
- Follow instructions in the SWP's and RMF's for the activities being undertaken, in particular the "Emergency Procedures" sections
- Not deviate from BRIL's established safety documentation (unless approval for deviation is granted by BRIL staff)
I agree to the above*

YesNo
Should be Empty: