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Blinn College Simulation & Clinical Lab Use Form
Purpose
The Blinn College Simulation & Clinical Lab welcomes the opportunity to partner with other programs to advance learning. The simulation facilities provide students with unique resources that are essential for clinical training and costly to maintain. Use of these facilities is therefore strictly regulated.
If you are interested in using any of the simulation spaces, please submit your request to the Simulations Department via email at blinnsimcenter@blinn.edu a minimum of thirty (30) calendar days prior to the proposed date of use. Submission of a request does not guarantee access to the room(s) or resources.
Someone from the Simulation Center will contact you regarding the specifics of your request and determine whether your needs can be accommodated.
Request Information
Name
Contact Phone Number
Email
Department / Program
Date(s) Requested
Course / Information to be Taught
Number of Attendees Expected
Spaces Needed
HiFi Lab Home Setting Virtual IV Room Clinic Space
EMS Lab OR Space Hospital Room(s) PTA Lab Radiology Technology
Terms of Use
I agree to the following terms of use (initial each point):
- In accordance with Blinn College policy for use of spaces of this size, there will be a faculty/student ratio of no more than 1/20 at all times.
- Simulation Lab supplies are off limits to guests. If supplies are required, requests must be made in writing to the Simulation Center a minimum of 30 calendar days prior to the event.
- The presence of animals and the use of animal parts and blood is strictly forbidden, except in approved procedures in designated situations.
- The person requesting use of the facilities assumes full responsibility for replacing materials that are damaged or lost as a result of their use.
- Tampering with or defacing equipment and/or mannequins is prohibited.
- The use of explosives, flammable substances, firearms, and/or weapons is strictly prohibited.
- A formal contract will be signed before use of the Simulation Center outlining damage agreement.
- Damage to any simulator, mannequin, and/or equipment is the responsibility of the leasee or renter.
I understand and agree to these terms
Print Name
Date
Print Name
Date
Approvals
Simulation Director Approval
Date
Allied Health Division Chair Approval
Date