OMNI Histology Project Registration

Every user MUST have completed this form and have their project approved BEFORE use of equipment can commence. Failure to do so may make you liable for any damages caused during unauthorised use.

USER DETAILS

Please complete all marked sections and other relevant options.
Name Name First Last
Department
Email
Phone Number
Status

Status Staff Principal Investigator Post-doc PhD Masters Postgraduate Other Undergraduate Other
Principal Investigator's Name (if you are part of a research team) Principal Investigator's Name (if you are part of a research team) First Last
Supervisor's Name (if you are a student) Supervisor's Name (if you are a student) First Last
Student ID Number
(If applicable)
Supervisor's or Principal Investigator's Email
Staff ID Number
Your own or your supervisor's. This is important for collating publications and is only used for this purpose.

This number is used to trace publications which included research done in the facility. It is important we find such publications for justifying future equipment purchases.
Granting body.
Allows us to collate funding sources and aids planning for new resources.

If your funder isn't here just tick other.
Start Date Start Date / DD / MM YYYY
Estimated End Date Estimated End Date / DD / MM YYYY
TECHNIQUE
Technique(s) Required

Technique(s) Required Processing Embedding Sectioning Cryostat Sectioning Paraffin Staining-H&E Staining-Special Stains IHC manual IHC Bond ISH/FISH/RNA Scope Slide Scanner Bright field Slide Scanner Flourescent ddPCR Other

Each separate item of equipment will require specific training and sign off from a staff member before work can commence
Brief Description of Project.

This information is used when making bids for equipment funding and is very important. Please take the time to describe your project clearly and concisely.
ACCOUNT CODE
Account Code

Your account code will begin with GL if it is a General Ledger account and PL if it is a Project Ledger account.
HEALTH AND SAFETY
Requires PC2 Containment?

Requires PC2 Containment? Yes No
Upload PC2 Training Form

Attach Files
Are you using human tissue?

Are you using human tissue? Yes No
Do you have any allergies? eg. latex gloves.

Do you have any allergies? eg. latex gloves. Yes No
List allergies, if relevant.
Additional Information

If you have specific requirements relevant to your project please describe them here.
Read Terms and Conditions at https://www.otago.ac.nz/omni/otago830788.pdf

Read Terms and Conditions at https://www.otago.ac.nz/omni/otago830788.pdf Yes

By ticking this box you acknowledge having read, and agreed with, the Terms and Conditions.

OMNI Histology Project Registration

OMNI Histology Project Registration

USER DETAILS

TECHNIQUE

ACCOUNT CODE

HEALTH AND SAFETY