Form A-PP - Contact Information

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The information provided in this checklist will help the Office of Biohazard Containment and Safety review the work objectives and program intent to determine the required Plant Pest Containment (PPC) level and provide recommendations on how to attain the desired PPC level.

Facility:

Contact Information:

1) Facility Supervisor (main contact)

Signature: space

2) Biosafety Officer (or equivalent)

Signature: space Date: space

Type of Facility:

Greenhouse checkbox

Screenhouse checkbox

Laboratory checkbox

Museum checkbox

Zoo checkbox

Educational Display checkbox

Modifications:

Upgrading Existing Facility checkbox

New Construction Site checkbox

Renovations checkbox

Other checkbox

Program Intent (brief description of the type of work and list procedures with the potential to generate aerosols, if applicable):

List of Pathogens (use scientific name and include species and subtypes where applicable):

List of Arthropods (use scientific name and include species and subtypes where applicable):

*Internal Use Only

Assessment of required PPC level:

checkbox Basic checkbox PPC-1 checkbox PPC-2 checkbox PPC-2A checkbox PPC-3

Extra requirements to consider:

space
Signature: Ottawa Plant Laboratory Authority:
space
Date
space
Signature: Office of Biohazard Containment and Safety Authority:
space
Date

The information you provide on this document is collected by (for) the Canadian Food Inspection Agency under the authority of Section 34 of the Plant Protection Regulations for the purpose of issuing a permit to import. Information may be accessible or protected as required under the provisions of the Access to Information Act.

Date modified: