06. PIADC Visitor Questionnaire STENS SITE VISIT JUNE 29, 2022.pdf

Date: 04/19/2022 Visitor Questionnaire File Plan: TBD

PIADC Visitor Questionnaire

We look forward to welcoming you to Plum Island Animal Disease Center (PIADC). In order to plan for your visit, we are required to fill out a Visitor Application on your behalf. Please provide the information requested below. If you are planning to go into biocontainment, additional information will be needed to process your clothing request. Thank you in advance.

Date of visit:

Name of Escort:

Purpose of visit:

Last Name:

First Name:

Middle Initial:

Are you a United States Citizen?

YES NO

Country of Citizenship: (if not United States)

Country of origin: (if not United States)

Company Name:

Company Address:

Phone Number:

Select your Ferry Schedule (see table below)

Connecticut Ferry (30 min travel time)

AM Ferry time (Departure from Old Saybrook Ferry- 26 Bridge Street Old Saybrook, CT)

PM Ferry time (Departure from PIADC)

New York Ferry (15 min travel time)

AM Ferry time (Departure from Orient Point- Orient Point, NY)

PM Ferry time (Departure from PIADC)

Will you require any of the following:

Network Connection (with or without GFE)

Laptop Equipment (borrowed or personal) (requires Wi-Fi access)

Video Equipment

Camera (Camera phones included)

Will you be going into containment? (if you answer no, questionnaire is complete)

If you answered yes:

Are you registered with the Select Agent Program?

Agency you will be visiting:

DHS Science USDA-APHIS USDA-ARS

Are you planning to observe lab activities?

Are you planning to conduct lab experiments under the supervision of assigned escort?

Clothing sizes Scrub size Female Male Scrub top

SM MD LG XL XXL

Scrub bottoms

SM MD LG XL XXL

Shoe size

Sports bra size

SM MD LG XL XXL