Principal Investigator: Protocol # (if available): Date: SECTION F: HAZARDOUS AGENTS USED IN ANIMALS Note: Protocols involving biohazards or recombinant materials cannot be approved without DES risk assessment and appropriate registration(s), approval(s) and supporting documentation (see below, F1b). F1. HAZARDOUS AGENTS a. Hazard type Check all that apply to this protocol. Human/NHP blood, cell culture or unfixed tissue * Toxicological agents * Agents infection plants, animals and/or humans (i.e. bacteria, virus, prion) * Other hazardous chemicals Radioactive materials Laser / irradiator / x-ray machines Research involving recombinant or synthetic nucleic acid (rDNA) molecules * Generation, purchase or use of transgenic animals * Carcinogens / mutagens Caustic agents Other: * Other: May require IBC registration and/or approval. Please refer to: http://www.des.umd.edu/general/committee/ibc/index.html b. Registrations and approvals Approval Type Approval # IBC Radiation Safety Other Registration not required Approval Date Approval Expiration Date c. Documentation Mark an “X” in applicable box(es): IBC approval letter(s) issued by DES has/have been uploaded to IRBnet. AGENT-SPECIFIC TRAINING Document has been uploaded to IRBnet. PI must place a copy of this document in the applicable animal room(s). N/A N/A All chemicals are covered under Chemical Hygiene Plan. All hazard-specific training required is included on the Personnel Qualifications Form (PQF). F2. HAZARDOUS AGENT USE (copy and complete a separate, additional F2 for each agent; please list specifics, e.g., strain, gene, cell line, etc.) a. Administration of agent / materials Hazard e.g., Infectious agent, human/NHP materials, rDNA Dose & Frequency of Administration Route of Administration Duration of Treatment b. Non-biohazards (for biohazards, see F2c, below) Containment (describe): Personnel protective precautions (describe): Length of time the agent remains a threat to animals or humans working with animals: c. Biohazards Containment level Mark an “X” in applicable box(es) ABSL-1 Personnel protective precautions (describe): ABSL-2 ABSL-3 Will biosafety cabinets or dump stations be used? Yes. Type of equipment: Location: Date certified: Will animals be housed in primary containment? Yes. Type of equipment: Location: Date certified: Means of caging and equipment decontamination. Describe: Method of animal waste and bedding decontamination before disposal. Describe: Method of animal carcass disposal. Describe: