Clearance Details: From: . Date Time

Charles Sturt University Form BSC 2 Biosafety Committee Version 1

Clearance for Maintenance Work Within/To a Biological Facility

I, ……………………………………………..[Name of Facility Manager], hereby authorise that

……………………………………………………… has been provided with basic biological safety information, and that the ………………………………………….[Name of Biological Facility],

Room…………, Building Number…., is now safe for entry.

Clearance Details: From:………………………….[Date]…………………[Time]

Until:…………………………..[Date]………………….[Time]

Induction Details:

…………………………………………………………………………………….

[Summary of Safety information imparted]

Job Details:

…………………………………………………………………………………….

[Description of Maintenance Work to be Performed]

D:\Docs\2017-11-30\09e827b20a7701a550b2185867bc4532.doc Signature of Facility Manager: Signature of Maintenance Officer:

……………………………………… …………………………………..

Date:………………………………. Date:…………………………………

(Note: Retain Copy With Laboratory Records)

D:\Docs\2017-11-30\09e827b20a7701a550b2185867bc4532.doc