ENGINEERING LABORATORY WORK REQUEST

GENERAL INFORMATION

PROJECT TITLE

BRIEF SUMMARY OF RESEARCH PROJECT

EXPERIMENTAL ANALYSIS

PROJECT DURATION FROM: TO:

NAME OF RESEARCHER/S

CONTACT DETAILS EMAIL: PHONE:

Existing Researcher
New Coursework Project
New Research and Higher Unit code:
Degree Candidate
RESEARCHER STATUS AND CoC period from: to:
Head of Course:
COST CENTRES
Deputy Dean of Research: Professor Steven
Moore Undergraduate - Dr Benjamin Taylor /
Postgraduate - Dr Prasad Gudimetla
Cost Code/s: Cost Code:
PJ-70-[campus]-A012-[]-X000-HE0000

INSTITUTE / SCHOOL / CENTRE

CNS / BDG / GLD / MEL / MKY / PTH / ROK / SYD / Other:

BASE CAMPUS AND LABORATORY (WHERE
EXPERIMENTS WILL BE CONDUCTED)
Room/s:
OTHER LABORATORIES (INCLUDING FROM
OTHER SCHOOLS) THAT YOU PLAN TO USE

(For laboratories from other schools/centres

you required to seek approval directly from
them)
PRINCIPAL SUPERVISOR/S

SPECIFIC INFORMATION
LABORATORY & WORKSHOP
SPACE / BENCH REQUIREMENTS

(Include m2 estimate)

LABORATORY SUPERVISOR NAME/S

LABORATORY SUPERVISOR TIME

REQUIREMENTS

(Provide details of time requirements over the

length of the project. Please discuss with
laboratory supervisor before completing this
section)

REQUESTED TO BE UNIVERSITY SUPPLIED TO BE SUPPLIED BY RESEARCHER

EQUIPMENT REQUIREMENTS

(E.g. Instruments, specialist glassware)

(Included all consumables and estimated costs)

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 SOFTWARE REQUIREMENTS

(All specialist software required for the project

and expected costs of software currently not
available at the University)

CHEMICAL REQUIREMENTS

(Included all consumables and estimated costs)

BIOLOGICAL REQUIREMENTS

RADIOISOTOPES LASERS OTHER

DETAILS:
RADIATION REQUIREMENTS
(Do you plan to use any of the following?)

OTHER REQUIREMENTS

(E.g. Field / Boating / OGTR / Animals & Type /

PPE )

SAMPLES CHEMICAL BIOLOGICAL OTHER

DRY COLD FROZEN ULT

(+4 C) (-18 C) (-80 C)

DETAILS:
STORAGE REQUIREMENTS

STORAGE TIME PERIOD FROM: TO:

REQUESTED TO BE UNIVERSITY SUPPLIED ALREADY POSSESSED BY RESEARCHER

SPECIALIST TRAINING REQUIRED

DISPOSAL PLANS

(i.e. Samples & Wastes)

DETAILS: BUILDING / ROOM No

KEYS OR SWIPE CARD FOR ROOM
ACCESS

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 “APPLICATION FOR AFTER HOURS ACCESS TO LABORATORIES ” FORM COMPLETED YES
AFTERHOURS WORK
NO

Complete the section relevant to you

Current Researchers and Research and Higher Degree Students

Submission
 Discuss the laboratory requirements with your supervisor(s) and relevant laboratory supervisor(s) before
completing this form.
 RHD students should get this approved before the confirmation of candidature or any laboratory work can
begin.
 Attach additional pages if required.

LABORATORY REPRESENTATIVE SIGNATURE DATE

School of Health Medical & Applied Sciences:

School of Engineering & Technology: Troy Simpson t.simpson@cqu.edu.au

All Other Schools: The laboratory representative for your campus

DEPUTY DEAN RESEARCH (FINANCIAL APPROVAL) SIGNATURE DATE

School of Health Medical & Applied Sciences:

School of Engineering & Technology: Steve Moore s.moore@cqu.edu.au

All Other Schools:

Coursework Project Students (Undergraduate/Postgraduate)

Submission
 Discuss the laboratory requirements with your supervisor(s) and relevant laboratory supervisor(s) before
completing this form.
 Students should submit this form with the risk assessment form.
 This form needs to be approved before any laboratory work can begin.
 Attach additional pages if required.

LABORATORY REPRESENTATIVE SIGNATURE DATE

School of Health Medical & Applied Sciences:

School of Engineering & Technology:

All Other Schools: The laboratory representative for your campus

HEAD OF COURSE (FINANCIAL APPROVAL) SIGNATURE DATE

School of Health Medical & Applied Sciences:

School of Engineering & Technology:

Undergraduate - Ben Taylor ben.taylor@cqu.edu.au
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 Postgraduate - Prasad Gudimetla p.gudimetla@cqu.edu.au
All Other Schools:

Approval
 Laboratory Technical Manager to distribute Laboratory Work Request form to relevant Laboratory
representative.
 The relevant laboratory representative will discuss with you your proposed laboratory work and assist you
in developing risk assessments.
 Given the complexity of some laboratory work activities the timeframe will vary depending on the activities
involved.
 Persons (RHD or Non-RHD) are not to undertake laboratory work until final approval has been given
by relevant stakeholders.

On Completion of Research
 Reinstate work area to original state if applicable.
 Return keys / swipe card, equipment, etc.
 Dispose of waste, chemicals, etc as per governing Regulations, Codes of Practice, Australian Standards,
etc.
 Once satisfied all work has been carried out contact laboratory representative who will inspect and
sign off completion.

LABORATORY REPRESENTATIVE SIGNATURE DATE

Submit completed “LABORATORY WORK REQUEST ” form to :

Research and Higher Degree Students

School of Graduate Research – sgr@cqu.edu.au

School of Engineering and Technology - s.wibowo1@cqu.edu.au

t.simpson@cqu.edu.au

School of Health, Medical and Applied Sciences -

Coursework Students

Submit this form with your risk assessment to your Academic Advisor.