Sample Submission Form

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User Name

Department/Company

Telephone Number

Supervisor Name (if appropriate)

Supervisor Email

To which spectrometer(s) does this risk assessment apply??

Sample Description

Hazard Statements e.g. H401

Handling Requirements e.g. gloves, eye protection, temperature control, sealed environment

If a risk assessment has already been completed, the document may be attached here in answer to the questions above.

Attach file

No files are currently attached.

Via waste solid and broken glass bins provided

Other

If other, please provide details:

All relevant information has been provided and my supervisor (in the case of PDRA, PhD, PGT, UG student users) has checked the details of this submission. The appropriate safety precautions will be taken and all samples will be disposed of as indicated above.

We reserve the right to refuse a sample for analysis on the basis of, but not limited to, any potential hazards which we deem unacceptable, and/or if there is insufficient information for the sample measurement to be conducted safely.

If samples are not disposed of correctly the user will be banned from making further bookings.

Privacy notice

The data on this form will be used to risk assess the proposed work. The information provided will be stored while you are a registered user of the inVia Raman spectrometers. The data will not be used for any other purpose.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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