Area Location  __________________________________________________________
  		  	(Street Address if Off Campus)

Principal Investigator____________________________ Office Phone _________

Office Location ________________________________   Home Phone ___________

Campus Box Number_____________________________     Department ___________

Authorized Personnel: 			           Dept. Head ___________




Emergency Numbers:	Campus Emergencies		         911
			Carolinas Poison Control Center    1-800-848-6946
			Other	________________________
				________________________
				________________________


SIGNATURES

Principal Investigator____________________________	Date____________


EH&S Center       ____________________________	Date____________
Representative


SAFETY PLAN NO.  ____________