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Research Environmental Questionnaire
Research Environmental Questionnaire
Name of Principal Investigator:
Email Address:
Name of Co-Investigator:
Email Address:
Lab Contact:
Email Address:
Name of Research Project:
University Unit:
(School or College)
Today's Date:
mm/dd/yy
Human Blood, Body Fluids or OPIM?:
Yes
No
Does this research involve the use of any of the following? (CHECK either "Yes" or "No"): (Provide as much detail as possible if YES)
Provide Detailed Information:
Recombinant DNA, Infectious Agents or Biological Toxins?:
yes
no
CHECK either "Yes" or "No": (Provide as much detail as possible if YES):
Provide Detailed Information:
Radioactive Materials and/or Ionizing or Nonionizing radiation Producing Equipment?:
yes
no
CHECK either "Yes" or "No": (Provide as much detail as possible if YES):
Provide Detailed Information:
Use of Animals?:
Yes
No
Provide Detailed Information:
Hazardous Chemicals:
Yes
No
Provide Detailed Information:
If material is not used, please answer not applicable (N/A)
Radioactive Material Storage:
If using radioactive material, how is it stored?
