Permit Request • CampusOptics

Use this form to gather Environmental Health and Safety (EH&S) specific information for each new potential project coming to RIT. The information gathered can be used to make decisions regarding regulatory compliance, incorporating engineering best management practices into the final project, and proactively preparing for EH&S related work activities.

Please click here for the Select Agents list, also available at http://www.cdc.gov/od/sap/.

Requester

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Project Overview Information

SRS Database Proposal #* Required

PI and co-PIs* Required

Department* Required

Project Title* Required

Project Type* Required

Has the Project been funded?* Required

Project Funded Date

Project Funded Anticipated Date

Where will the work be taking place? Building:* Required

Room:* Required

Anticipated Project Start Date* Required

Anticipated Timeframe for new materials and/or Equipment.* Required

If new equipment will be coming to RIT, what information will be made available to EH&S?* Required

Equipment Specifications – General
Equipment Specifications – Chemicals Used
Air Emission Estimations
Waste Generation Data
Machine Guarding
Electrical Safety
Other

If other above, please descirbe.

Environmental Health & Safety Information

Are hazardous materials, radiation sources or lasers are being used?* Required

Are they the same materials that have always been used in the room(s)?* Required

Any new chemicals? If so, what are they?* Required

If Yes above Chemical Name and CAS #

Any new radioactive material sources?* Required

If Yes above Chemical Name and CAS #:

If there are new radioactive material sources, has the RSO been notified? * Required

If there are new radioactive material sources, has an amendment already been requested to RIT’s Radioactive Materials License?* Required

Any new Bloodborne Pathogen materials being used?:* Required

Any new biological substances?* Required

If Yes above provide name

Are any of the new biological substances on the select agents list (see attached list, also available at http://www.cdc.gov/od/sap/)?* Required

Are there any identified EH&S training needs associated with this project?* Required

If Yes above please provide traiing description

Detailed Project Information

Project Description* Required

Specific Project Aims - A.* Required

Specific Project Aims - B.* Required

Specific Project Aims - C.* Required

Specific Project Aims - D.* Required

Research Design* Required

Research Methods?* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files