Get Potentially Hazardous Biological Agents Risk Assessment Form 6a

Potentially Hazardous Biological Agents Risk Assessment Form 6A Required for research involving microorganisms rDNA fresh/frozen tissue blood and body fluids. SRC/IACUC/IBC approval required before experimentation* Student s Name s Title of Project To be completed by Student Researcher s in collaboration with Qualified Scientist/Designated Supervisor All questions are applicable and must be answered additional page s may be attached* 1. Identify potentially hazardous biological agents to be used in this experiment. Include the source quantity and the biosafety level risk group of each microorganism* 2. Describe the site of experimentation including the level of biological containment. 3. Describe the procedures that will be used to minimize risk. personal protective equip* hood type etc* 4. What final biosafety level do you recommend for this project given the risk assessment you conducted 5. Describe the method of disposal of all cultured materials and other potentially hazardous biological agents. 1. What training will the student receive for this project 2. Do you concur with the biosafety information and recommendation provided by the student researcher above o Yes No If no please explain* 3. Experience/training of Designated Supervisor as it relates to the student s area of research if applicable QS/DS Printed Name Signature Date of Signature o The SRC has carefully studied this project s Research Plan and the risk level assessment above prior to experimentation and approves this study as a BSL-1 study which must be conducted at a BSL-1 or above laboratory. Date of SRC approval before experimentation o This project was conducted at a Research Institution and was reviewed and approved by the appropriate institutional board e*g* IACUC IBC before experimentation at a BSL-1 or BSL-2 laboratory and complies with the Intel ISEF rules. The required institutional forms are attached* o The Research Institution where this study was conducted does not require approval for this type of study. The student has received proper training and the project complies with Intel ISEF rules. Attached is a letter from an institutional representative certifying the above. SRC Chair s Printed Name Signature International Rules Guidelines for Science and Engineering Fairs 2011-2012 www. SRC/IACUC/IBC approval required before experimentation* Student s Name s Title of Project To be completed by Student Researcher s in collaboration with Qualified Scientist/Designated Supervisor All questions are applicable and must be answered additional page s may be attached* 1. Identify potentially hazardous biological agents to be used in this experiment. Include the source quantity and the biosafety level risk group of each microorganism* 2. Identify potentially hazardous biological agents to be used in this experiment. Include the source quantity and the biosafety level risk group of each microorganism* 2. Describe the site of experimentation including the level of biological containment. 3. Describe the procedures that will be used to minimize risk.