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Get Colorado State University Biosafety Incident/Near Miss Report Form 2019-2024

SU ID: First Name: Last Name: Email: Phone Number: Yes No Alt. Phone Number: Emergency Contact Information Name: Name: Phone #: Alt. Phone #: Phone #: Alt. Phone #: Principal Investigator/ Supervisor Name: Name: Incident Information Pathogen working with: Does the pathogen contain recombinant DNA or synthetic nucleic acid molecules? Location (building, room): Yes No Date and Time of Incident: Incident Type (exposure, physical injury, etc.): Incident Description.

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