OMNI Histology Registration For External Users

Every user MUST have completed this form and have their project approved BEFORE use of the Histology facility can commence.

USER DETAILS

Please complete all marked sections and other relevant options.
Name Name * First Last
Affiliation *
Email *
Work Phone Number
Mobile Phone Number
Postal Address Postal Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
PROJECT DETAILS
Anticipated Start Date Anticipated Start Date * / DD / MM YYYY
Anticipated End Date Anticipated End Date * / DD / MM YYYY
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 Scanning Bright Field Slide Scanning Flourescent ddPCR Other
Brief Description of Project. *

Describe your project clearly and concisely. This information is used when making bids for equipment funding and if there is anything that you would prefer not to be publicly disclosed please make a note of this.
The project has been discussed with the following OCEM staff member(s) prior to registering: *

The project has been discussed with the following OCEM staff member(s) prior to registering: Rob Porteous Vicky Clark Tania Slatter

This helps us coordinate your project amongst all the other ones we receive. It's better for everyone if you make time to discuss your project with one of the staff before you register it.
ACCOUNT DETAILS
Purchase Order Number
Will you be collaborating with a staff member of the University of Otago and using a University account code?

Will you be collaborating with a staff member of the University of Otago and using a University account code? Yes No
University of Otago Account Code
HEALTH AND SAFETY
Will your sample require PC2 containment? *

Will your sample require PC2 containment? Yes No
If your sample requires PC2 containment please include why (is the sample a risk good, animal cell culture, new organism, GMO, unwanted organism or an uncleared biological product?).
Will you be working on site at the Histology Unit? *

Will you be working on site at the Histology Unit? Yes No
If you will be working on site in the Histology Unit, please list any relevant allergies (e.g. latex gloves).
Additional Information
TERMS AND CONDITIONS OF USE
I have read the Histology Units https://www.otago.ac.nz/omni/otago830788.pdf *

I have read the Histology Units 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 Registration For External Users

OMNI Histology Registration For External Users

USER DETAILS

PROJECT DETAILS

ACCOUNT DETAILS

HEALTH AND SAFETY

TERMS AND CONDITIONS OF USE