Membership Request Form

Request General Information

Company Name	Your Name
Email of Primary POC This will be the email of the Paying Member of your team
Is your company a new member or a current member of Greentown? NewCurrentIf you are recently admitted or a prospective member, please select "new"	What location is this request for? Somerville (HQ)Houston (HTX)Submit a unique form for each location related request
What does this request apply to? Employees (On/offboarding or changing memberships)Lab Space (Prototyping/Wet Lab)Desk Space (Moving Location)Company Offboarding

Employee Requests

What is the request?

Onboard an EmployeeOffboard an EmployeeChange Employee Contract

Offboarding Employee(s)

If you have multiple employees to offboard, please fill out this section for the first, click "Add another response" in the bottom right, and fill out again for each employee.

Name of Departing Employee

Last Day/ Expected Departure Date

Did the Employee have a Parking Space?

YesNo

Is the Employee a Safety Rep (Prototyping or Wet Lab)?

YesNo

Is the Employee a Bill Paying Member?

YesNo

Is the Employee a Wet Lab User?

YesNo

Is the Employee on the Greentown VPN?

YesNo

Is there anything else we should know?

Onboarding Employee(s)

If you have multiple employees to onboard, please fill out this section for the first, click "Add another response" in the bottom right, and fill out again for each employee.

New Employee Name

New Employee's Company Email Address (No Personal Email Addresses, Please!)

New Employee's Title

First Date Employed/Expected Date of Arrival

Will this Employee need Wet Lab Access?

YesNo

What HQ Membership Type will this Employee Have?

Desk (includes designated desk and key fob)Chair (includes key fob)Offsite (virtual access only - they will be on-site no more than 4 days a month and will sign in as a guest)

What HTX Membership Type will this Employee Have?

Desk (includes designated desk and key fob)Offsite (virtual access only - they will be on-site no more than 4 days a month and will sign in as a guest)

Is there anything else we should know?

Change Employee Contract(s) - HQ

If you have multiple employee contracts to change, please fill out this section for the first, click "Add another response" in the bottom right, and fill out again for each employee.

Employee Name

What kind of Contract does the employee currently have?

Desk (includes a designated desk and a key fob)Chair (includes a key fob - please make sure this falls in line with our 1:1 desk to key fob policy)Offsite (GRID access only - they will be here no more than one day a week and will sign in as a guest)

What kind of Contract do you want them to have?

Date of change:

Change Employee Contract(s) - HTX

If you have multiple employee contracts to change, please fill out this section for the first, click "Add another response" in the bottom right, and fill out again for each employee.

Employee Name

What kind of Contract does the employee currently have?

Desk (includes a designated desk and a key fob)Offsite (GRID access only - they will be here no more than one day a week and will sign in as a guest)

What kind of Contract do you want them to have?

Desk (includes a designated desk and a key fob)Offsite (GRID access only - they will be here no more than one day a week and will sign in as a guest)

Date of change:

Lab Space Request

What is your Request?

Add Prototyping SpaceAdd Wet Lab Bench(es) (HQ ONLY)Reduce Prototyping Lab SpaceReduce Wet Lab Bench(es) (HQ ONLY)

Do you currently have Prototyping Lab Space?

YesNo

Prototyping Lab Intake

Ideal Start Date in Prototyping Lab

Are there any potentially hazardous elements to your prototyping?

YesNoI'm not sure...

If you are working with an identified hazardous substance, procedure, or potential for danger please identify those items here, now, so that we can understand your needs and serve you as best as possible. If you are already doing this procedure in another space similar to ours (or not!) - please let us know how your company thinks about safety, training, hazard analysis, regulatory compliance and documentation.

How much total space do you want to begin with (in square feet)?

How much space do you expect to need in 12 months time?

Are you expecting to bring anything BIG into the lab? Things that won't fit through normal double doors or that would require a forklift or that would themselves be driven. Anything you won't be moving yourselves or that you'll contract riggers to move? Do you expect to need a forklift to move anything in/out of your space?

YesNoOther

Please explain...

Do you have any height requirements for your prototyping? A large portion of the prototyping lab at 444 Somerville Ave. features 7ft ceilings. The prototyping lab at 28 Dane St. has mostly 15ft+ ceilings (with a few spaces with some limitations).

7 ft ceilingHigher than 7 ft ceiling needed

Do you have any height requirements for your prototyping? The majority of space is 19' with areas under ductwork at 16'. A small section below the storage mezzanine has 9' of clearance. All objects entering or exiting the building must fit through standard double doors.

9 ft ceilingHigher than 9 ft ceiling needed

How high of a ceiling do you need?

Do you need access to water or drainage in the lab? If so, your needs will be reviewed by the Greentown Labs Safety Team

YesNoOther

Please explain:

Electricity and High-Voltage Circuits
Do you work with open circuits and/or high-voltages? Will you need access to outlets greater than 110 V 15 A? Electrical enhancements and customizations are enabled and organized by the Greentown Labs Operations Team. All upgrades are at the cost of members and may be subject to metering including being charged for the cost of power. Requests will be submitted via JIRA, our ticketing system, on date of lab space delivery.

YesNoOther

Please explain:

Chemicals / Hazardous Materials
Will you be bringing any chemicals or materials into the space that are rated/regulated as flammables, toxic, corrosive, reactive or that pose potential for hazard in an exposure or uncontrolled release situation? Chemicals with a NFPA rating of 3 or 4 or GHS category of 1, 2 or 3, nano materials or potent compounds? If the answer is yes - please send a complete chemical inventory to safety@greentownlabs.com before your ideal move-in date.

YesNoOther

Please explain...

Heavy Metals
Do you work with any heavy metals or does your work create any heavy metals as byproducts? Do you work with lead (even leaded solder)? If the answer is yes - please prepare a complete material inventory before you plan to bring any of it on-site.

Noise
Do you anticipate making any loud noise (louder than 75db) for any period longer than 3 minutes at a time? Do you anticipate making any noise louder than 100db at all? Ever?

Batteries
Will you be storing any quantity of battery cells that would special handling or considerations? Any lithium-polymer batteries? Any cells with large capacity or that you expect to prototype charging systems on? Do you develop any battery products including battery management systems?

Lasers
Does any part of your prototyping include Class 3, 3B, or 4 lasers?

Radiation
Does your prototyping or do any pieces of equipment you plan on using generate radiation?

Vents
Do you need to vent any pieces of equipment? Do you need access to fresh air?

Air Filter / Control
Do you anticipate creating ANY vapors, powders, dusts or particulate that won't be controlled at the point-source? Do you plan on using a ductless fume hood in your space? Does any part of your prototyping or work take place in a glovebox? Will you be introducing any ovens, furnaces, or environmental chambers into the space?

Food
Does any part of your prototyping include working with or manipulating food in the lab?

YesNoOther

Please explain...

Plants
Does any part of your prototyping involve growing plants in the lab?

YesNoOther

Please explain...

DNA / GM
Do you work with DNA in any capacity? Do you work with anything genetically modified in any capacity?

YesNo

Please explain...

Floor
Do you have any special requirements about the floor on which you work? Surface finish or load-bearing or other.

YesNoOther

Please explain...

Privacy
Does your work require any degree of privacy that you are hoping to build into your space?

YesNoOther

Please explain...

Anything else operations/safety you need us to know about that was not covered in the above questions?

Additional Prototyping Space

How much space (in square feet) are you looking to add?

When do you need this space by?

Is there anything else you would like us to know?

Reducing Prototyping Space

How much space (in square feet) are you looking to remove? What will the new total be?

OLD, NEW

When do plan to relinquish the space?

Is there anything else you would like us to know about the lab space specifically?

Do you currently have Wet Lab Space?

YesNo

Wet Lab Intake

Please briefly explain your Experiment/Science

What is your ideal Starts Date in the Wet Lab?

How many benches do you need to start?

Future Growth
Do you foresee a need for additional benches in the future? While we cannot 'hold' benches, we will take this into consideration when onboarding new companies, or moving current ones.

YesNoMaybe

Do You Need to Bring Anything BIG In To the Lab?
Large incubator, glove boxes, furnace, analytical equipment, custom equipment, etc.

YesNoMaybe

What equipment, please describe it and share any information.

If you have any manuals/data sheets please upload

If "maybe" please explain

Personnel
Each member of your company that will be using the wet lab will need to complete additional safety training. Please let us know who will be using the lab (names and emails) so we can set them up with these trainings as soon as possible.

Please Designate one Member as your Safety Representative
This person will attend monthly lab meetings, participate in peer audits, and is the main point of contact between the Wet Lab Management and your member company

Facilities, Resources & Hazards

Please note that the following are not allowed in the Wet Lab at Greentown Labs

• BSL 3 and 4 Organisms

• Radioactive Materials

• Ethidium Bromide

• Live Animals

• Open Flames

• Select Agents

• Controlled Substances

• Biological Toxins

This list is also subject to change and is not fully inclusive of what Greentown Labs may decide not to permit in the wet lab

Electrical
Will you need access to anything above and beyond 110v 10amp?
Electrical enhancements and customizations are enabled and organized by the Greentown Labs Operations Team. Requests will be submitted via JIRA, our ticketing system, on date of lab space delivery.

YesNoMaybe

Please explain your electrical needs

Please upload any manuals/cut sheets for your equipment

Gasses/Plumbing
Will you need any gasses other than those provided by Greentown? Please note we have compressed air, vacuum, and nitrogen gas onsite. Any other gas needs will need to be obtained by each member company—we can help by getting you in touch with our preferred vendor, AirGas

YesNo

What gasses will you need/be bringing into the wet lab?

Heavy Metals
Does any of your work involve the use, generation, or disposal of heavy metals?

YesNo

Please list which metals and approximate volumes you expect to work with

Noise
Do you anticipate making any loud noise (louder than 75db) for any period longer than 3 minutes at a time? Do you anticipate making any noise louder than 100db at all? Ever?

YesNoMaybe

Batteries
Will you be storing any quantity of battery cells that would special handling or considerations? Any lithium-polymer batteries? Any cells with large capacity? Do you develop any battery products including battery management systems?

YesNoMaybe

Lasers
Does any part of your wet lab work include Class 3, 3b, or 4 lasers?

YesNo

Food
Does any part of your prototyping include working with or manipulating food in the wet lab?

YesNo

Plants
Will you be bringing plants into the Wet Lab?

YesNo

Floor
Do you have any special requirements about the floor on which you work? Surface finish or load-bearing or other.

YesNoOther

DNA / GM
Do you work with DNA in any capacity? Do you work with anything genetically modified in any capacity?

YesNo

Microbes
Do you work with Microbes in any capacity?

YesNo

Please Upload your Biologics Inventory (microbes, DNA, Genetic Material, etc...)

Please list and provide a brief description of any and all potentially hazardous elements to your research. If you are working with an identified hazardous substance, procedure, or potential for danger please identify those things here now so that we can understand your needs and serve you as best as possible. Please share how you are currently are or plan to mitigate these hazards.

Are you currently carrying out these experiments at another facility?

YesNo

If you are already doing this procedure(s) in another space - please let us know how your company thinks about regulatory compliance and documentation

Job Safety Analysis
As part of our safety program, we ask that your company complete a Job Safety Analysis for your work. While it is not immediately required, it will be required before you can begin your work. The sooner we receive your JSA the sooner we can begin reviewing your processes and make sure they are a good fit and safe for our shared space! If you would like to start one now you can find the template here: http://bit.ly/JSATemplate

You may upload multiple JSAs by clicking the "Add another response" button in the right corner.

Upload Your Chemical Inventory
Please include a full list of all chemicals, gasses, etc. that you wish to bring into the wet lab

Hazardous Wastes
Once you start in the lab, our wet lab technician and waste disposal vendor will work with you to simplify and optimize your hazardous waste streams. In order for us to prepare for you, please provide as much detailed information in your answers to the questions below.

Do You Expect to Generate any Biological Waste? How Much on a Monthly Basis?
Please describe in as much detail as possible and make your best estimate on total volumes

Do You Expect to Generate any Chemical/Hazardous Waste? How Much on a Monthly Basis?
Please describe in as much detail as possible and make your best estimate on total volumes

Equipment
It is critical that Greentown understands what needs you have, if they are being met, and what will be within the wet lab. Current Wet Lab offerings can be found here.

Please refer to the list of wet lab equipment that will be included in the wet lab (above). Is there anything we do not have that is ABSOLUTELY CRITICAL to what you do?

Please upload a list of equipment you will bring onsite and keeping on your benche(s)

Do you have a list of "nice to have" equipment you would like to share?
Greentown is working with current and potential sponsors to build out our catalog of shared equipment, if there's anything you'd like us to add to our list of requested equipment, please it here!

Is there anything else facilities, operations, or safety-related that you need us to know about that was not covered in the above questions?

Additional Wet Lab Bench(es)

How many benches were you looking to add? What will the new total be?

Using the Map above, which bench would you like to have and why?
We cannot guarantee that you will receive that bench but will try our best to accommodate any location needs you may have.

When do you need the bench(es) by?

For what reasons(s) are you requesting additional benches?

More Room for Same Experiments/WorkflowsMake Room for New Experiments/WorkflowsHouse New Equipment

What is this new equipment?

Will this equipment/addition of this equipment require more than 110V 10A?

YesNoMaybe

Please upload manual/cut sheet for equipment

Please upload a JSA for this new workflow/experiment. Template can be found here: http://bit.ly/JSATemplate
You may upload multiple JSAs by clicking the "Add another response" button in the right corner.

Is there anything else facilities, operations, or safety-related that you need us to know about that was not covered in the above questions?

Reducing Wet Lab Space

How many benches were you looking to relinquish? What will the new total be?

Using the Map above as reference, which bench(es) are you relinquishing?

When are you planning on relinquishing the bench(es) by?

Is there anything else you would like us to know?

Were any changes/modification made to the bench or space? (electrical upgrades, equipment installations, plumbing changes, etc...)

YesNo

Please list any changes made to the space

Which of the following did you work with on the bench(es)?

BiologicsHeavy MetalsFlammablesCorrosivesReactives/Oxidizers Respiratory HazardsNone of the Above/Other

If "None of the Above/Other" please explain

Please make sure to decontaminate your bench(es) and equipment using this protocol.

Is there anything else facilities, operations, or safety-related that you need us to know about that was not covered in the above questions?

New Member Space Request

What kind of Lab Space do you want?

Wet Lab Intake - New MemberPrototyping Intake - New Member