Permit Request • CampusOptics

Requester Info

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

Name* Required

Additional Location Details

Event and Contact Information

Event name* Required

Department / organization* Required

Designated individual (organizer/presenter)* Required

Email* Required

Phone* Required

Event date* Required

Start and end time* Required

Building(s)* Required

Room(s) / location(s)* Required

Number of minors expected* Required

Age range* Required

Number of adults / chaperones* Required

Primary on-site contact* Required

Brief event purpose and agenda* Required

Authorization Form: Procedure / Protocol

Activities, demonstrations, procedures, protocols, or techniques to be observed* Required

Materials, equipment, organisms, specimens, or processes to be observed* Required

Laboratory areas and route to be visited* Required

Type of area (check all that apply)* Required

Other area

Safety Procedures and Personal Protective Equipment (PPE)

Other hazard(s)

Describe controls, viewing location, safe route, supervision plan, and emergency procedures* Required

Additional safety instructions, restrictions, or conditions

Proposed Training

Description

Supporting Documentation

Attachments checklist* Required

Map or route, if applicable
Event agenda or description
Participant roster
Other supporting documentation

Designated Individual (Organizer/Presenter) Certification

Designated Individual (organizer/presenter) name* Required

Title* Required

Individual completing the form* Required

Date* Required

Add Supporting Documents

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

Files