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BOOKING FORM
Accredited Online Training Package: Safe Transport of Division 6.2 Infectious
Substances, Biological Specimens, Dry Ice & Related Materials
Complete the booking form below IN FULL, SCAN AND EMAIL to Mark Ariyanayagam,
m.r.ariyanayagam@qmul.ac.uk (Health & Safety Directorate (HSD), 404 Bancroft Road, Mile End
Campus)
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Trainee First name and Surname:
Trainee’s QMUL email address AND telephone extension:
School / Institute & Centre / Directorate:
Training Module sections required*: (if not specified, sections I and E, 1-5 & 7-11 will be
applied as default).
I - Introduction, 1- General Familiarisation, 2 – Overview of DG Shipping, 3 – Classification, 4 – Exempt Patient
Specimens, 5- Cat B Infectious Substances, 6 – Cat A Infectious Substances, 7 – Genetically Modified
Organisms, 8 – Dry Ice, 9 – Liquid Nitrogen, 10 – Overpacks, 11- Preservatives with Infectious Substances, E –
Preparing for Exam Information at https://www.training.saftpak.com/About.aspx?cust=SafTPak
School or Institute Budget and Account Code to be charged for the module cost of £85.
Budget Code:
Account Code:
I agree for the re-imbursal of the above noted amount to HSD Budget Code SAF1000B
Account Code 1820:
Budget Holder Name:
Budget Holder Signature:
Date:
I certify that the person named above has been allocated the role of ‘Shipper’ of
Infectious Goods and related materials:
Head of School or Director of Institute Name:
Head of School or Director of Institute Signature:
Date:
-------------------HSD use only
Activation Code:
Password:
Date issued:
QMUL_HS_081_Online Module Booking Form_Infectious Substances Transport