<p> Charles Sturt University Form BSC 2 Biosafety Committee Version 1</p><p>Clearance for Maintenance Work Within/To a Biological Facility</p><p>I, ……………………………………………..[Name of Facility Manager], hereby authorise that </p><p>……………………………………………………… has been provided with basic biological safety information, and that the ………………………………………….[Name of Biological Facility], </p><p>Room…………, Building Number…., is now safe for entry.</p><p>Clearance Details: From:………………………….[Date]…………………[Time]</p><p>Until:…………………………..[Date]………………….[Time]</p><p>Induction Details:</p><p>…………………………………………………………………………………….</p><p>…………………………………………………………………………………….</p><p>…………………………………………………………………………………….</p><p>[Summary of Safety information imparted]</p><p>Job Details:</p><p>…………………………………………………………………………………….</p><p>…………………………………………………………………………………….</p><p>[Description of Maintenance Work to be Performed]</p><p>D:\Docs\2017-11-30\09e827b20a7701a550b2185867bc4532.doc Signature of Facility Manager: Signature of Maintenance Officer:</p><p>……………………………………… …………………………………..</p><p>Date:………………………………. Date:…………………………………</p><p>(Note: Retain Copy With Laboratory Records)</p><p>D:\Docs\2017-11-30\09e827b20a7701a550b2185867bc4532.doc</p>