IBC Number:
Ana G. Méndez University System
VICE PRESIDENCY FOR PLANNING AND ACADEMIC AFFAIRS
ASSOCIATE VICE PRESIDENCY FOR SPONSORED PROGRAMS
OFFICE OF REGULATORY COMPLIANCE
P.O. Box 21345 San Juan, PR 00928-1345
Phone: 787-751-0178 ext. 7195, 7197 FAX: 787-759-6411
compliance.suagm.edu
IBC Form 3
Hazardous Chemicals Report
All chemicals or mixture of elements and/or compounds which represent a physical or health
hazard to humans under the registered investigation must be informed to the IBC. Use this form
to report any chemical which falls within the following categories: flammable, combustible,
explosive, oxidizing, pyrophoric, reactive, organic peroxide or compressed gas. Note that
chemicals are not subject to registration, but they do have to be reported to the IBC as they may
pose a threat to personnel if handled without caution.
New registration
Resubmitted registration
I. Basic Information
1. Principal Investigator Name:
2. E-mail:
3. Phone/ Fax:
4. Department/School:
5. AGMUS Institution:
6. Funding Agency (if applicable):
7. Project Title:
8. Laboratory Location:
BSL-1
9. Identify the Biosafety Level of the Laboratory:
BSL-2
N/A**
**Research or academic laboratories where
no biological agents or rDNA/rRNA are
currently stored or used.
II. Additional Information
1. Mentor/ Co-investigator’s
Name:
2. E-mail:
3. Phone/ Fax:
4. Department/School:
IBC_Hazardous_Chemicals_03
Approved through (5/2011)
Revised (5/2010)
1
AGMUS
Eng_Ver_01
5. AGMUS Institution:
III. Hazardous Chemical Information
1. Is a chemical safety cabinet available:
Yes
No
2. Is a fume hood available in the laboratory (if
applicable):
Yes
No
3. The Storage cabinets is:
Flammable
N/A
Corrosive
4. Provide a brief summary of significant risks and precautions to be taken for each chemical.
Important: Attach a list of all chemicals that are: flammable, combustible, explosive,
oxidizing, pyrophoric, reactive, organic peroxides or compressed gases.
5. Provide a written emergency plan for handling accidental spills and personnel exposure (if
applicable).
IV. Personnel
Identify the personnel involved with these chemicals (including students, technicians,
temporary help, etc.) and their respective responsibilities. Provide a copy of their curriculum
vitae indicating their level of training and experience in working with the chemicals.
Name:
E-mail:
Phone/ Fax:
Department/School:
AGMUS Institution:
Project Responsibility:
Name:
E-mail:
Phone/ Fax:
Department/School:
AGMUS Institution:
Project Responsibility:
V. Applicant’s Agreement
I certify that:
a. I have attached a copy of the following documents to this registration:

A list of all chemicals to be use in the registered investigation which are flammable,
combustible, explosive, oxidizing, pyrophoric, reactive, organic peroxides or
compressed gases.
IBC_Hazardous_Chemicals_03
Approved through (5/2011)
Revised (5/2010)
2
AGMUS
Eng_Ver_01

Information about the personnel indicating their level of training and experience
working with chemicals.

Written procedures describing the potential hazards and precautions to be taken.

Written emergency plan for handling accidental spills and personnel exposure.
b. All personnel conducting this work have received orientation on the specific risks
associated with the handling of the chemicals and the specific laboratory safety
procedures required during their handling. My records documenting this instruction may
be reviewed.
c. I understand that the Material Safety Data Sheets (MSDS) for each chemical shall be
available for all employees and collaborators.
d. Any spill, facility failure or inappropriate handling/storage that could result in potential
exposure of laboratory personnel and/or the public will be reported.
e. When I no longer plan to use a chemical reported in this form, the IBC will be notified of
the proper disposal mechanism according to state and federal regulations in writing (if
applicable).
f.
I have read and understand my responsibilities as Principal Investigator and will comply
with these responsibilities. The information provided herein is accurate to the best of my
knowledge.
Signature of Principal Investigator
/
/
(mm/dd/yy)
Signature of Dean
/
/
(mm/dd/yy)
/
/
Submit this completed form to the AGMUS’ Office of Regulatory Compliance.
IBC Use Only
Identify Biosafety level approved:
BSL-1
BSL-2
Does not apply
Identify the availability of a chemical safety cabinet
or fume hood in the laboratory (if applicable):
Yes
No
Identify the availability of storage cabinets (if applicable):
Flammable
Corrosive
/
/
(mm/dd/yy)
IBC Chair Signature
/
IBC-signed copy returned to Registrant
IBC_Hazardous_Chemicals_03
Approved through (5/2011)
Revised (5/2010)
3
AGMUS
Eng_Ver_01