Microorganisms Registration Form – Institutional Biosafety Committee

Principal Investigator or course instructor:

Department:*

Email*

Enter Email Confirm Email

Phone number:*

Project title:*

Will the microorganisms be used in a class, if so, which class(es)?*

Locations where microorganisms will be used (building and room number)

Locations where microorganism stocks will be stored (building and room number)*

Are biohazard warning labels in use in the storage and use locations ?*

Yes
No

Are any of the agents you will use a:*

human pathogen
animal pathogen
plant pathogen
insect pathogen
potentially transmitted between animals and humans
unknown

List the Genus, species and strain names of Risk Group 1 (RG1) microbes to be used

List the Genus, species and strain names of Risk Group 2 (RG2) microbes to be used.Indicate whether it is pathogenic to humans, plants, or animals*

What cells, tissues, animals, humans, insects, or plants will be exposed to the microbes (such as host cell lines for viruses, animals infected etc)?

Is a toxin produced?*

Yes
No
unknown

If yes, will you be working with the toxin?

Yes
No

Is drug resistance expressed?*

Yes (different or additional drug resistances compared to the wild type)
No (just inherent resistance already present in wild-type)

If yes, indicate to which drugs:

What is the source of this material (ATCC, colleague, other)?

Maximum quantity of material to be used for experiment or stock cultures:*

Less than 1L
1-10L
Greater than 10L

Is organism inactivated prior to use in experiments?*

Yes
No

If yes, by what specific method?

If you concentrate the organism in your protocol, indicate the concentration method:

Will the biohazardous materials listed above be administered to animals, humans, or plants?*

If yes, please contact IBC Chair. Additional forms will be required.

Yes
No

Please provide a BRIEF description of proposed use of the microorganisms*

Optional File Upload

You can upload a lab procedure, course handout, or other document to describe your experiment(s)

Drop files here or

Max. file size: 32 MB.

Safety Measures

Indicate any engineering controls used to prevent potential contamination:*

Containment suite (e.g. BSL-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?*

Please review your protocol to minimize the use of sharps for RG2 organisms. Use sharps with built-in 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
other

If other, please specify

Disinfection method for solid waste cleanup and disposal*

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

Disinfection method for liquid waste spills, clean-up, and disposal*

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

-- Principal Investigator's Assessment of Risk --*

What is the most serious adverse effect you can foresee as a result of this experiment?

Principle Investigator's assessment of the IBC Category to which this experiment belongs*

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.

Only RG1 agents are used. No health or biosafety risks. Registration, but not approval, is needed
RG2 agents are used and IBC must approve prior to initiating experiments

Additional Comments