Send original to:
MaryAnn Taylor
Sponsored Research – Provost Office
Phone 274-1206 Fax: 274-3064 OR
Email: biosafety@ithaca.edu
USE OF POTENTIALLY INFECTIOUS AGENTS/MATERIALS
Ithaca College Biological Safety Committee
Principal Investigator:
Phone#:
Department:
Fax#:
Proposed Locations (incl. Bldg./Room and off-campus sites):
Biological organisms or materials involved in this work (humans, animals, birds, plants):
Infectious agents that pose the greatest risk of infection associated with the organisms/materials listed above or the
environment in which the work is done: (All human material work must be performed under universal precautions
and must be considered positive for HIV, Hep B, and Hep C.)
Brief description of project (include start date/duration if appropriate) in terms understandable by the general public:
Check the proposed containment level (NB: work involving Class 3/4 agents or work at BSL 2+ or higher is not
permitted at Ithaca College:
 BSL1
 BSL2
 BSL2 +
Principal Investigator
 BSL3
 BSL3+
Date
(Signature)
Additional Investigator:
Date
(Signature)
Reviewed by
Date
(Biosafety Officer)
1
Risk Assessment:
Describe the biohazard potential of this work and consider the following in your response: routes of transmission,
virulence and infectivity; the severity of the disease it causes (include the signs and symptoms of exposure); natural
vector; immunizations; effective therapies; and expected quantity of the agent (volume and concentration). Is
restricted access to your laboratory or classroom required when working with organisms?
Standard Operating Procedures:
Provide a set of Standard Operating Procedures that will be employed y to ensure safe handling of the organisms
from the initiation and use through decontamination and disposal of wastes. List each task that will be performed,
what type of physical containment devices will be used, and the type of personal protective equipment that will be
worn for each task. Do not describe decontamination procedures here (see below). Is restricted access required? If
so describe the procedures to ensure this.
Attach additional pages if necessary.
Equipment & Supplies:
List the equipment and supplies that will be used with these organisms.
2
Transport:
Will organisms or biological material be transported to or within Ithaca College?
 Yes
 No
If yes, to what locations (Bldg/rooms)?
How will they be transported and what methods will be used to contain the materials during transport?
Containment:
Please describe containment procedures and/or methods to limit/control exposure on campus and/or off campus
Storage:
List the storage location (building/Room) and the type of storage (e.g, freezer, -80, liquid nitrogen) of the materials
if not in use:
Is access limited at this location?  Yes
If yes, describe measure to ensure limited access.
 No
Disinfectants and Decontamination:
List disinfectant(s) and concentration(s) that will be used for decontaminating work surfaces, facilities and
equipment:
Describe procedures that will be used to disinfect and decontaminate work surfaces, equipment, and facilities
Describe the methods of disposal of anatomical parts, organs, tissues, cells, carcasses or other materials
Is autoclaving required?
 Yes
 No
If so, how will material be transported to the autoclave?
3
Animals:
Animal species:
# animals used at any one time:
Total # animals stored on campus:
Medical Surveillance:
Describe the procedures used to inform students/research personnel, especially currently pregnant or
immunosuppressed individuals, of possible hazards, including hazards to immunosuppressed individuals.
Are there any restrictions for handling these agents?  Yes
If yes, what are the restrictions?
 No
Emergency Response Procedures:
Please describe the emergency response procedures for the following incidents:
(refer to the OEHS Biosafety Spill Response Guide or OEHS Biological Safety Manual for assistance).
Puncture wound, bite, or parenteral exposure:
Exposure to mucous membranes of face:
Exposure to aerosols:
Exposure to fluids including spills (blood, urine, saliva, etc):
4