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UMass Lowell - EHS

Biological Agents Inventory Forms


University Of Massachusetts Lowell
 
Primary Investigator:   

Telephone:

Department:   
 Lab Building:  
  
Room #:   
Lab Contact:   
 Telephone:  
Please List All infectious agents (including blood), recombination DNA, human origin material (including human cell lines), Biotoxins and BSL-1 agents.
If you have any questions, contact Richard Lemoine, EHS Office at ext. 2618.
Agent Biosafety Level Used Active use
in Lab
[Yes/No]		 Active use in animals
[Yes/No]		 IACUC T#
(if applicable)
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Yes
No 		Yes
No 		Yes
No
Lab Safety Personnel working with hazardous agents
Name Telephone Lab Location
Laboratory Accident Information
Have any incidents/accidents occurred in your lab within the past 12 months ? Yes No
If yes please explain..
Was this reported to the EHS? Yes No
Date Reported:
 Date of Occurance:
Injured Person(s):
EHS - Kitson Hall 115, One University Avenue, Lowell, MA 01854
Phone: 978-934-2618 Fax: 978-934-4018 Contact Us

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