Fillable Access form Departme Superviso Emergency Contact # Employee/ (University of Ottawa)

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Access form Departme Superviso Emergency Contact # Employee/ (University of Ottawa)

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The Access form Departme Superviso Emergency Contact # Employee/ (University of Ottawa) form is 3 pages long and contains:

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  • 10 check-boxes
  • 25 other fields

Country of origin: CANADA
File type: PDF

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mail:
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Student #:
Contact:
nt:
Please provide the following information:
Access form
First Name
Employee/
Emergency
Departme
Room #:
Start date:
Last Name
uOttawa E
Contact #
Superviso
Extension
End date:
Are you a new student / staff with uOttawa?:
):
Status (Select the most appropriate one):
Request for (Select the most appropriate
Mandatory training for all paid personnel, students (honours and co-op) and volunteers:
WHMIS Office or WHMIS Laboratory
Worker Health and Safety Awareness
Respect In the Workplace
Violence Prevention
Accessibility Standards for Customer Service
Working Together: The Code and the AODA
Digital Self-Defence
Mode 1: What to do if someone discloses an alleged incident of sexual violence
Mandatory training for all supervisors:
Supervisor Health and Safety Awareness
Mandatory for all wet laboratory personnel:
Laboratory Safety
Autoclave Safety
Job-specific training:
Principles of Biosafety
Radiation Safety
Principles of Laser Safety
Access card # (first 5/6 digits):
Faculté de médecine
Faculty of Medicine
Bureau de la gestion du risque et de la santé-sécurité
Health, Safety and Risque Management
medsafety@uottawa.ca
8/10/2020
8/10/2020
Faculté de médecine
Faculty of Medicine
Bureau de la gestion du risque et de la santé-sécurité
Health, Safety and Risque Management
medsafety@uottawa.ca
Page 2
Access to 4206 4206A
Hours: All hours Business (Mon-Fri)
Signature of Flow Cytometry Core Facility Manager
Date
Authorization by CBIA Core Staff:
Access to
3140
Hours: All hours Business (Mon-Fri)
Signature of CBIA Core Facility Manager
Date
Hours requested: Business hours (Mon-Fri, 7am-6pm. Excludes holidays)
All hours (24hr. Includes weekend and holidays)
If you require access to the Animal Care & Veterinary Services (ACVS), please see Wendy Ip in RGN 1311. You will
need to bring your access card with you. Please note: Access cards with ACVS access expire every year, therefore,
you will need to renew your access card on a yearly basis.
Authorization by Flow Cytometry Core Facility Staff:
Supervisors:
You must ensure that your delegates are competent to work safely without supervision when you
request “all hours” access. New personnel and undergraduate students are recommended to have
restricted access until they gain the required skills and experience. Access can be extended at a
later date, as required.
Access requests:
New access cards will be initially programmed with a one month expiry from the date of issue. This
allows time for users to complete all their mandatory training, and to provide the relevant
training documentation (certificates) to the departmental offices, on page 3. Once the mandatory
training documentation is provided, then the one month expiry date will be removed.
Please indicate which room(s)/lab(s) and/or areas you require access to:
Access card # :
8/10/2020
Faculté de médecine
Faculty of Medicine
Bureau de la gestion du risque et de la santé-sécurité
Health, Safety and Risque Management
medsafety@uottawa.ca
Page 3
Card/keys Regulations
- You are personally responsible for your access card/keys.
- Cards used in unauthorized areas or outside of authorized time periods will trigger an alarm. This
alarm and the card number will be recorded by the security server.
- An access controlled door held open for more than 120 seconds will trigger an alarm.
- If you lose your card/keys or have it stolen, you must report it to your department’s card
administrator or Protection Services immediately.
- Never lend your access card or keys, or allow unauthorized persons to enter an area for which they
don’t have a card or keys. Ask them to contact Protection Services, lending your access card/
keys to another person will result in the withdrawal of all access privileges.
- Unauthorized persons found in access control areas should be reported to Protection Services.
- At the end of your time at the University of Ottawa, keys and cards must be returned to your
administrative office.
Signatures and confirmation
I, (your name) have read and confirm that I understand the rules and
instructions governing the University of Ottawa access card system. I recognize that both Protection
Services and my service or academic unit manager reserve the right to cancel my card if I fail to follow the
rules and instructions.
Student/Employee Signature Date
Supervisor’s Signature* Date
*Note: Supervisor’s signature is not required if Core Facility access is being requested.
What to do with this form
Please fill out this form electronically, after printing the form and attaching any relevant training
documentation, the form can be handed to the following locations:
For personnel in Biochemistry, Microbiology and Immunology (BMI) and Cellular and Molecular Medicine
(CMM) RGN 3206A
For personnel in School of Epidemiology and Public Health (SEPH): 600PM 101G
For personnel in Kidney Research (KRC): RGN2527
For personnel in Neuroscience (NRI): RGN 1411
For personnel in Pathology: RGN 4155
For personnel wanting access to Flow Cytometry Facility: RGN 4166
For personnel wanting access to CBIA Core: RGN 3171
For personnel in administrative departments or others not listed above: RGN 1106
Access card # :
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Access form Departme Superviso Emergency Contact Employee (University of Ottawa)

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Completed 27 May 2022

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