Researchers Applying for Department of Defense (DOD) Grants Are Required to Have the Department

Researchers applying for Department of Defense (DOD) grants are required to have the Department of Environmental Health and Safety (DEHS) sign-off on the DOD’s “Certificate of Environmental Compliance”.

Before this certificate can be signed the following documentation and/or information is required.

1.)“Certificate of Environmental Compliance”,2.) grant abstract, 3.)and this Form

must be emailed, faxed, mailed, or delivered to W-140 Boynton Health Service:

Fax 612-624-1949 Questions: 612-626-6002

Please Sign off on all items that are relevant to the grant.By signing you agree to abide by the terms and provide any required documents with your request.

Does this project involve any of the following materials?

Yes No Chemicals

If “yes” whichdepartment’s LabSafety Plancovers this work? .

Attach yourwritten safety protocol (SOP) for the intended research, include a description of

hazards and measures to mitigate the hazards. Attach copies of your lab safety and hazardous waste training records (these should be current within the last year). A template for SOPs is on the web at

Web modules for training are also on the web

Yes No Human blood, bodily fluids, human cells (including cell lines), or other
potentially infectious material

If “yes”, by signing you agree to completeBloodBorne and Infectious Material training and provide training for your staff and inform them about the Hepatitis B Virus and Immunization for HBV before beginning work on regulated material.

YesNo Recombinant DNA, Infectious agents or Biological Toxins

If “yes”,by signing you agree to file with the Institutional BiologicalSafety Committee and obtainapproval for your proposal before you do any work on the project.

Yes NoAnimals (Vertebrate)

If “yes” by signing you agree to file with the InstitutionalAnimalCare and Use Committee (IACUC)and obtain approval for your proposal before you do any work with animals.

Yes No Radioactive Materials and/or Ionizing or Nonionizing Radiation Producing Equipment

If “yes” be aware you will have to file with Radiation Protection and take the required training before working with radioactive material.

Researcher’s name / X500 of PI
Signature / Phone number
Sponsoring PI’s Name / Lab building & room #
PRF# / Date
Study contact name / Phone number