Human blood and tissue registration – Institutional Biosafety Committee

Principal Investigator or course instructor:*

Department:*

Email*

Enter Email Confirm Email

Phone number:*

Project title:*

Does your study require IRB approval? If so, please provide the IRB protocol number, or "pending" and provide the number to the IRB upon receipt*

Locations where human tissues will be used (building and room number)*

Locations where human tissues will be stored (building and room number)*

Describe the samples to be used. What is the tissue, are there tissues known or expected to be infected with human pathogens?*

Please provide a brief description of proposed use of human tissues*

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

Work with human tissues must be done in BSL2 spaces

The workspace is already designated BSL2
The storage space is already desgnated BSL2
I need help to determine if my space is BSL2

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

Yes
No

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

Human tissue must be disposed of as Regulated Medical Waste following disinfection. Please indicate the location (room number and building) of the RMW disposal bin you will use:*

Training and Medical

Please confirm the following:*

Please confirm the following:

Personnel have received blood borne pathogen training from the PI within the past year or will be trained prior to initiation of work
Personnel have received basic laboratory training from the PI within the past year or will be trained prior to initiation of work
All personnel who will potentially be in contact with blood, bodily fluids, or uncharacterized human cell lines, have received (or will receive prior to starting work) a Hepatitis B vaccine or have proven immunity

Is additional vaccination required for this project?*

Yes
No
Other: if yes, specify which vaccine:

Please upload your biosafety training plan. An example plan is provided at the top of this page.*

Max. file size: 32 MB.

Human Blood and Tissue Registration Form

Safety Measures

Training and Medical