Safety form for the FACS unit, Weizmann Institute of Science

Date: Day:   Month:   Year:  

Head of Project:

Full Name:
Institution:
Department:
Work Phone:
Cellular Phone:
Work Fax:
Email Address:
   

Student, Staff, Physician, Scientist or Guest

Full Name:
Institution:
Department:
Status:
Work Phone:
Cellular Phone:
Work Fax:
Email Address:
Describe, in short, your project involving the FACS

Cell types to be measured at the FACS unit

Species

Source of the cells

Status of the cells (freshly prepared, cultured from fresh, blood bank or long term cell line)

Are the cells checked for HIV?     Yes    No
Are the cells checked for HBV?   Yes    No

Are the cells fixed  Yes    No

If yes, with what?

Please specify any potential risk factors:

Please specify if there are carcinogenous or poisonous materials in the sample apart from the cells:

  

 

 

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