Registration Form Chemistry lab

This form needs to be submitted for evaluation at least seven days prior to the proposed starting date. For questions, please contact Anna-Marie Runge (7am - 2pm).

Last Name ^*

First Name ^*

Title

Affiliation ^*

Email address ^*

Telephone number

Who will use the Chemistry Lab? (name, first name) ^*

HZB-employee ^*

yes no

if yes, unit

Group Leader

User ^*

yes no

if yes, Contact at HZB

Other, please specify

Proposal Number ^*

Start Date ^*

Anticipated duration of the proposed experiment ^*

Expected date and time of arrival at HZB ^*

Detailed description of the experiment(s) to be performed in the Chemistry Lab ^*

Complete list of equipment and chemicals to be used for the experiment in the Chemistry Lab. ^*

Complete list of equipment to be brought into the Chemistry Lab ^*

Complete list of Chemicals and substances to be brought into the ChemLab (Please note: for each chemical or substance brought into the Chemistry Lab, a Material Safety Data Sheet has to be provided). ^*

Is there any hazardous potential associated with the chemicals and substances you bring into the Chemistry Lab? ^*

yes no

If yes, please detail

Do you require storage space in the Chemistry Lab? ^*

yes no

If yes, how much?

Complete list of chemicals and substances to be stored in the Chemistry Lab (Please note: the maximum storage time cannot exceed the duration of this access proposal). ^*

Will you produce waste in the Chemistry Lab as a result of the proposed experiment? ^*

yes no

If yes, please detail

If yes, how is the disposal organized

Declarations

Please note the Data Protection Declaration

I agree to personal data processing and utilization according to the HZB data protection ^*

Declaration ^*

I hereby declare that I have filled out the access request form to the best of my knowledge, that I have read and understood the Directive for Operations (Betriebsanweisung) for the Chemistry Lab and that I am responsible for the correct labelling and storage of all chemicals and substances, which I will bring into the Chemistry Lab and store there, and for the removal of all waste material, which is produced as a result of my experiments in the Chemistry Lab.

Declaration/Data storage ^*

This data is stored for ten years. Legal regulations make the storage period necessary. By ticking this box on the online form, I agree to personal data processing and utilization according to the HZB data protection information for forms and HZB data protection.

Registration Form Chemistry lab

This form needs to be submitted for evaluation at least seven days prior to the proposed starting date. For questions, please contact Anna-Marie Runge (7am - 2pm).

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