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RPI Controlled Substances Application
Principal Investigator
Principal Investigator
Department
Department
Telephone Number
Telephone Number
Date
Date
Storage Location
Storage Location
Building/Room
Name of Controlled Substance and Drug Schedule
Name of Controlled Substance and Drug Schedule
List each Controlled Substance and its drug schedule.
Will there be authorized users other than the PI?
Yes
No
Number of Authorized Users in Addition to the PI
Number of Authorized Users in Addition to the PI
- None -
1
2
3
4
5
Additional Authorized User Information - 1
Name of Additional Authorized User
Name of Additional Authorized User
Email
Email
Phone
Phone
Additional Authorized User Information - 2
Name of Second Additional Authorized User
Name of Second Additional Authorized User
Email
Email
Phone
Phone
Additional Authorized User Information - 3
Name of Third Additional Authorized User
Name of Third Additional Authorized User
Email
Email
Phone
Phone
Additional Authorized User Information - 4
Name of Fourth Additional Authorized User
Name of Fourth Additional Authorized User
Email
Email
Phone
Phone
Additional Authorized User Information - 5
Name of Fifth Additional Authorized User
Name of Fifth Additional Authorized User
Email
Email
Phone
Phone
Offices located at 41 Ninth Street.
Director of EHS (518) 276-6114
Staff Directory
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