Application to the Safety Committee

Section II: Project Description

Please provide the following information
1. Provide the primary hypotheses or research questions of the work.
2. Describe the experimental design of the work.
3. Identify any applicable Federal, State, and local regulations including required applications and any required permits and licenses.
Attach copies of any required permits and licenses.

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4. Identify the hazards to health and property in both the field and laboratory associated with this work.
5. Describe how the hazards to health and property in both the field and laboratory associated with this work identified above will be mitigated.
6. Describe all waste(s) produced by this work and the associated disposal procedures.


Beam Shape is:
Dimensions at Aperture (mm):
Divergence (mrad) (circular, elliptical, mult array, rectangular):
Beam Interlocks are fail-safe or defeatable

Section IV: Additional Information for Committee
Please add any other information that would help explain this project to the Committee below. (limited to 2,000 characters)
Section V: Certification of Principal Investigator and Co-Investigator Responsibilities

and

Section VI: Administrative Assurance and Approval of Application
1. Download and/or print the Safety Committee Application Signature pages.
2. Have appropriate persons sign in ink.
3. Scan completed signature pages and attach below.
4. Submit application.
Attach scanned copy of completed Safety Committee Application Signature Pages *

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Should be Empty:

Section III: Risk Assessment