Instrument Usage Reporting Form

User Information

Name(Required)

Email(Required)

Enter Email Confirm Email

Sample Source Information

In this section, describe whose samples were analyzed.

The analyzed samples are for...(Required)

For whom did you utilize the instrument(s)?(Required)

company name, department name, etc.

Point of Contact(Required)

Within the department or company, who is the point of contact for the samples? If you are a student and the samples are for your own project, please list your advisor's name.

Client's email address

If unknown, leave blank.

Funding Source(Required)

Who should be billed for the instrument use--grant source, department, company, etc. If you are unsure of the funding source, write "unknown".

Basic Usage Information

Please enter the basic details of your instrument use below.

Brief description of project(Required)

What type(s) of samples were tested?(Required)

Which instrument(s) did you use?

Select all that apply.

Anapro Ethylene Oxide Sterilizer

Yes

Number of samples run(Required)

For each sample, list the date of the run.

Anton Paar Mercury Intrusion

Yes

Date(s) of use and number of samples analyzed(Required)

Gel Permeation Chromatography (GPC)

Yes

Date(s) of use and number of samples analyzed(Required)

Mechanical Compression

Yes

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Transmission Electron Microscope (TEM)

Yes

What type of usage?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Scanning Electron Microscope (SEM)

Yes

What type of usage?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

X-Ray Diffractometer (XRD)

Yes

What type of usage?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Raman Spectroscopy (SERS)

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Micromeritics ASAP-2020 (BET) Analysis

Yes

What type of use?(Required)

Self-use

Staff-assisted use

What type of analysis was performed?(Required)

Surface Area analysis only

Surface Area analysis + full scale ads./des. isotherm and pore size analysis

Surface Area analysis only: Date(s) of use and number of samples analyzed(Required)

For each date, list the number of samples analyzed.

Surface Area analysis + full scale ads./des. isotherm and pore size analysis: Date(s) of use and number of samples analyzed(Required)

For each date, list the number of samples analyzed.

Which CINS staff member assisted you?(Required)

Atomic Force Microscope (AFM)

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

UV/Vis/NIR Spectrophotometer

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

X-Ray Photoelectron Spectroscopy (XPS)

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Thermogravimetric Analysis/Differential Scanning Calorimetry (TGA/DSC)

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Ultramicrotome

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Spectrofluorometer, Horiba NanoLog

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Nano Indenter

Yes

What type of use?(Required)

Self-use

Staff-assisted use

Date(s) and hour(s) of use(Required)

For each date, list the number of hours used.

Which CINS staff member assisted you?(Required)

Comments

Enter any additional relevant information below.

About CINS

Education

Innovation

CINS Instrument Usage Report

User Information

Sample Source Information

Basic Usage Information

Which instrument(s) did you use?

Comments

Contact