Fillable Memorandum Of Understanding And Agreement On BiosafetyName: Date: Principal (University of Guelph)

Fill Online, Printable, Fillable, Blank Memorandum Of Understanding And Agreement On BiosafetyName: Date: Principal (University of Guelph) Form

Use Fill to complete blank online UNIVERSITY OF GUELPH pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Memorandum Of Understanding And Agreement On BiosafetyName: Date: Principal (University of Guelph)

On average this form takes 6 minutes to complete

The Memorandum Of Understanding And Agreement On BiosafetyName: Date: Principal (University of Guelph) form is 2 pages long and contains:

  • 2 signatures
  • 9 check-boxes
  • 10 other fields

Country of origin: CANADA
File type: PDF

Canada forms for University of Guelph

BROWSE UNIVERSITY OF GUELPH FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
University of Guelph
Agreement on Biosafety
Name: ____________________________________________________ Date: _________________
Principal Investigator: __________________________________________________________________
Version 2 – January 26, 2017 Page 1
I have read and will comply with the University of Guelph’s Biosafety Policy.
I will work in accordance with the University of Guelph’s Biosafety program, Canadian Biosafety
Standard and any other applicable legislation, including conditions of the Biohazard Permit.
□ Yes
I have been trained on the use of and know the exact location of the eyewash, safety shower, fire exit,
spill kit and first aid kits.
□ Yes
I have been fully trained on the specifics of my work and am confident to start performing such work. I
have been informed of the risks associated with this work. I have read all applicable Safety Data Sheets
and Pathogen Safety Data Sheets.
□ Yes
I will notify my supervisor or their designate, and the Biosafety Officer, of any incident or exposure,
and will also complete the required Illness or Injury Incident Report :
https://www.uoguelph.ca/hr/system/files/IR%20-%20A14.pdf
□ Yes
I will notify my supervisor or their designate, and the Biosafety Officer, of any violations of safety
requirements, or any inadvertent release of biohazardous materials to the environment. I will
cooperate fully in any investigation of these matters.
□ Yes
I will wear required Personal Protective Equipment, including footwear with closed toes and heels, and
be fit-tested as required by EHS if respiratory personal protective equipment is used.
□ Yes
I know that as an individual handling potentially hazardous biological substances (animals, plants,
bacteria, fungi, viruses, toxins, etc.), I may be exposed to agents that can affect my health. If I have or
have had one of the following medical conditions, I will contact Occupational Health and Wellness at
ext. 52647 to make an appointment to meet with the Occupational Health Nurse/Physician.
1. Cancer of any kind
2. HIV-positive status
3. Diabetes
4. Taking oral steroid therapy
5. On immunosuppressive treatment
6. Severe allergic reactions
7. Any medical condition that may be impacted by working with biohazardous materials,
e.g. pregnancy, splenectomy, chronic lung disease, eczema.
If I should develop any of the above conditions, I will notify Occupational Health and Wellness
immediately, at (519) 824-4120, ext. 52647. If I transfer to another biohazard permit, I will again notify
Occupational Health and Wellness.
□ Yes
I recognize my responsibility to observe these practices and precautions while present in the
laboratory and understand their importance for the safety and welfare of myself, all others in the
laboratory, and the environment.
□ Yes
There may be some instances whereby vaccinations are recommended for the materials handled. This
includes but is not limited to work with untreated (raw) sewage and human blood, body fluids, tissues
or cell lines. I have been advised of any immunizations recommended for work with this agent(s).
□ Yes
University of Guelph
Agreement on Biosafety
Name: ____________________________________________________ Date: _________________
Principal Investigator: __________________________________________________________________
Version 2 – January 26, 2017 Page 2
Certification:
I recognize my responsibility to observe these practices and precautions while present in the laboratory
and understand their importance for the safety and welfare of myself, all others in the laboratory, and
the environment.
____________________________ ____________________________
Signature of Individual Signature of Principal Investigator
____________________________ ____________________________
Print Name Print Name
Date________________________ Date________________________
Attention: Biosafety Principal Investigators (Permit Holders)
Please submit a signed copy of this form for each investigative staff
member listed in your Biohazard permit application, including yourself,
along with your Biohazard Permit application.
The original of this agreement, must be kept in your office/lab.
Note that your records may be audited during a lab inspection.
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Memorandum Of Understanding And Agreement On BiosafetyName: Date: Principal (University of Guelph)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 23 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document