Recombinant DNA Registration Form – Institutional Biosafety Committee

General Information

Principal Investigator:*

Department:*

Email*

Enter Email Confirm Email

Phone number:*

Project title:*

Location where rDNA research will be conducted (building name and room number):*

This experiment will involve the following recombinant DNA methods (choose all that apply):*

Cloning of DNA encoding toxin molecules lethal to vertebrates at an LD50 of less than 100ng/kg
Human subjects (including human gene therapy)
Transfer of drug resistance to an organism not know to naturally acquire that trait, if such an acquisition could compromise ability to control the disease in humans, veterinary medicine, or agriculture
RG 2 agents as host-vector systems
Cloning of DNA from RG 2 microorganisms into nonpathogenic prokaryotic or lower eukaryotic host-vector systems
Use of infectious DNA or RNA viruses or defective DNA or RNA viruses in the presence of helper virus tissue culture systems
Use of transgenic animals at RG 2 or above
Use of viable rDNA modified microorganisms involving whole animals or whole plants
Administration of rDNA to animals or plants
More than 10L of culture
1-10L of culture
Less than 1L of culture
Propagation and maintenance of tissue culture of rDNA containing less than 2/3 of the genome of any eukaryotic virus in the demonstrable absence of helper virus or a virus that has been show to be non-replicating
Propagation and maintenance in tissue culture of rDNA containing a virus that has been shown to be non-replicating
Formation of rDNA containing no more than 2/3 of the genome of any eukaryotic virus
Use of transgenic animals at RG 1
rDNA not in an organism or virus
DNA segments from a single non-chromosomal or virual DNA source
DNA entirely from a prokaryotic host when propagated only in that host
DNA entirely from a prokaryotic host when transferred to another host by well-established physiological means
DNA from a eukaryotic host when propataged only in that host or closely related strain of the same species
DNA segments from different species that exchange DNA by known physiological processes
Use of a helper virus

Specify the genus, species, gene name, and gene product (if it is to be expressed) of the DNA source. More than one can be listed:

Name or description of the vector (plasmid, virus, or phage) used for constructing your recombinants:*

Genus, species and strain of host cell(s) or packaging cell line in which recombinant vector will be amplified.*

E. coli strains derived from K12 are exempt from IBC approval but must still be registered. DH5a, TOP10 are commonly used K12 derivates. Strain BL21 is not exempt. For more strain information, see "What Must be Registered" and "Risk Groups" for more information.

Will the inserted gene(s) be expressed?*

Yes
No

Does the donor rDNA, RNA, or cDNA source, the expressed product, or the vector have any recognized or anticipated pathogenic, toxigenic, or viral potential for animals, plants, or humans?*

Yes
No

If yes, please specify:

Are any viral components or sequences present?*

Yes
No

If yes, specify the nature of the viral components:

What cells, tissues, animals, humans, insects, or plants will be exposed to the recombinant?

Will you work with transgenic animals?*

Yes
No

Please provide a BRIEF description of proposed research*

Safety Measures

Indicate any engineering controls used to prevent potential contamination:*

Containment suite (e.g. RG 2)
Biocontainment animal housing (if applicable)
Class II biological safety cabinet
Centrifuge safety cups
Other

If other, please specify:

Will syringes, scalpels, glass, or other sharps be used?*

Sharps used at RG 2 should be minimized. If sharps are used, review your protocol to minimize use of sharps and use devices with integrated safety features where possible.

Yes
No

Indicate any Personal Protective Equipment (PPE) that will be required for your work:*

Lab coat
Safety glasses
Apron or rear-fastening gown
Bonnet or other hair cover
Gloves

For spill clean up, please indicate disinfectant methods.*

Autoclave
1/10 bleach solution
Poviodone or iodine product
70 percent ethanol
Phenolic product
Cholorine dioxide product
Quaternary ammonium product
Other

If other, please specify

Solid waste cleanup*

Autoclave
1/10 bleach solution
Poviodone or iodine product
70 percent ethanol
Phenolic product
Cholorine dioxide product
Quaternary ammonium product
Other

If other, please specify

Liquid waste cleanup*

Autoclave
1/10 bleach solution
Poviodone or iodine product
70 percent ethanol
Phenolic product
Cholorine dioxide product
Quaternary ammonium product
Other

If other, please specify

Animal waste cleanup*

Autoclave
1/10 bleach solution
Poviodone or iodine product
70 percent ethanol
Phenolic product
Cholorine dioxide product
Quaternary ammonium product
Other
not applicable

If other, please specify

Principle Investigator's assessment of IBC approval category*

Your estimation of what category your work falls under. (See "What Must Be Registered"). The IBC or IBC Chair will review the registration and confirm your risk category.

Exempt from IBC approval: Low risk rDNA work using exempt E. coli strain k12 or derivative
Notify IBC prior to initiation, no need to wait for approval: Low risk rDNA work using RG1 microorganism
Wait for IBC approval before initiating experiment: Higher risk rDNA or uses RG2 agent

Additional Comments: