University of Wisconsin Oshkosh Office of Grants and Faculty Development Institutional Biosafety Committee Biological Risk Assessment IBC Use Only Submission Date: Require Registration? (Yes/No): I. Cover Sheet: Project Identification, Personnel and Signatures Principal Investigator/Instructor: Department/Division: Building/Lab Room #: Phone No: E-Mail: Type of Review: Initial 3 Year Risk Assessment Review Principal Investigator or Instructor Certification: By signing below I am agreeing that the information provided is true and accurate of the work currently performed under my supervision as Principal Investigator or Instructor. I realize that any work utilizing biological materials, even if such materials are considered exempt from NIH Guidelines, may still require registration with the UW Oshkosh Institutional Biosafety Committee. I understand that I will also be required to complete biosafety training if my research is registered with UW Oshkosh Institutional Biosafety Committee. Signature of PI and/or Instructor: Date: Signature of Institutional Biosafety Chair: Date: Risk Assessment Directions: Investigators and/or instructors should complete the following questions based on their ongoing or future teaching or research needs. Complete this risk assessment for each biological agent, toxin of biological origin, virus or recombinant DNA project in your laboratory or classroom. Useful definitions can be found in Appendix B: “Definitions”. Submit completed form electronically to biosafety@uwosh.edu. Investigators should keep a copy in their records. Useful Resources: Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th Edition NIH Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules American Biological Safety Association (ABSA) Risk Group Database American Type Culture Collection (ATCC) 1 University of Wisconsin Oshkosh Office of Grants and Faculty Development II. Biological Materials Identify the biological materials used in your teaching and/or research then complete the following questions for each biological material identified. For additional rows, see Appendix A: “Additional Biological Materials” Biological Material (Agent, Pathogen, Biotoxin, Fungi, Virus, rDNA) Include genus and species as applicable 1. Human Pathogen/ Hazard (Y/N)? Animal Pathogen/ Hazard (Y/N)? Plant Pathogen/ Hazard (Y/N)? Risk Group Classification* Potential Transmission/ Exposure Route** Culture volume > 10 liters? (Y/N)? 2. 3. 4. 5. *Risk Group Information See Appendix B: “Definitions” and the American Biological Safety Association (ABSA) website for a Risk Group Database for Infectious Agents to determine the appropriate Risk Group Classification for your material(s). Additional information on Risk Group Classification can be found in Appendix C: “Examples of Selected Microorganisms and Associated Risk Group.” ** Modes of Infectious Transmission/Exposure Select the potential routes of transmission for the materials or organisms you will be working with. Examples may include: Inhalation Ingestion Skin absorption Contaminated blood/tissue/bodily fluids Fomites Vector transfer III. Potential Risks If risks exist for any of the biological materials listed on this form, please select all risks that apply and explain below: Splash potential Aerosol generation (cell culture, vortex, centrifuge, aerosol chamber, sonicator) Needle stick/poke Vector transfer Other: __ _________________________ If risks are selected, please explain below: IV. Location Explain where material use will occur. Include building and room/lab numbers and any satellite facilities. Type of Room Provide course Provide classroom number if work will be number if work will (Classroom, Laboratory, Building Room No. performed as part of a be performed as Procedure room, Animal class activity part of a class Housing, Cold Room, etc.) activity 2 University of Wisconsin Oshkosh Office of Grants and Faculty Development Appendix A: Additional Biological Materials Biological Material (Agent, Pathogen, Biotoxin, Fungi, Virus, rDNA) Include genus and species as applicable 6. Human Pathogen/ Hazard (Y/N)? Animal Pathogen/ Hazard (Y/N)? Plant Pathogen/ Hazard (Y/N)? Risk Group Classification* Potential Transmission/ Exposure Route** Culture volume > 10 liters? (Y/N)? 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 3 University of Wisconsin Oshkosh Office of Grants and Faculty Development Appendix B: Definitions Recombinant and synthetic nucleic acid molecules: The NIH Guidelines define recombinant and synthetic nucleic acids as: Molecules that are a). constructed by joining nucleic acid molecules and b). that can replicate in a living cell Nucleic acid molecules that are chemically or by other means synthesized or amplified, including those that are chemically or otherwise modified but can base pair with naturally occurring nucleic acid molecules Molecules that result from the replication of those described above. Risk assessment is a methodology used to organize and analyze scientific information in order to estimate the probability and severity of an adverse effect. The adoption of this methodology leads to the implementation of an appropriate set of measures in order to provide maximal protection of human health and the environment. Risk assessment has the following subsequent steps: Identification of biological hazards Determination of the class of risk of the genetically modified or pathogenic organism (Risk Group Classification) Consideration of the type of activity in terms of probability of exposure to potential biological hazards Assignment of a class of risk to the contained use activity (Biosafety Level) Implementation of recommended containment level * Risk Groups: Risk Group 1 (RG1): Agents are not associated with disease in healthy adult humans. Biosafety Level 1 (BSL-1) containment will be used following “NIH Guidelines for the Research Involving Recombinant or Synthetic Nucleic Acid Molecules” and Biosafety in Microbiological and Biomedical Laboratories, 5th Edition Risk Group 2 (RG2): Agents are associated with human disease which is rarely serious and for which preventative or therapeutic interventions are often available. Biosafety Level 2 (BSL-2) containment will be used following “NIH Guidelines for the Research Involving Recombinant or Synthetic Nucleic Acid Molecules” and Biosafety in Microbiological and Biomedical Laboratories, 5th Edition Risk Group 3 (RG3): Agents are associated with serious or lethal human disease for which preventative or therapeutic interventions may be available. Biosafety Level 3 (BSL-3) containment will be used following “NIH Guidelines for the Research Involving Recombinant or Synthetic Nucleic Acid Molecules” and Biosafety in Microbiological and Biomedical Laboratories, 5th Edition. UW Oshkosh does not currently have facilities to support BSL3 work Risk Group 4 (RG4): Agents are likely to cause serious or lethal human disease for which preventative or therapeutic interventions are not usually available. Significant containment is required using Biosafety Level 4 (BSL-4) containment. UW Oshkosh does not currently have facilities to support BSL4 work 4 University of Wisconsin Oshkosh Office of Grants and Faculty Development 5 University of Wisconsin Oshkosh Office of Grants and Faculty Development Appendix C: Examples of Selected Microorganisms and Associated Risk Group Microorganisms Selected Microorganisms Risk Group 1 Acanthocheilonema viteae Alcaligenes faecalis Bacillus megaterium Bacillus subtitlis Clostridium sporogenes Enterobacter aerogenes Enterobacter cloacae Escherichia coli (except toxigenic virotypes) Kocuria rosea (Micrococcus roseus) Lactobacillus spp. Leuconostoc spp. Micrococcus luteus Mycobacterium smegmatis Neisseria sicca Neisseria subflava Pseudomonas fluorescens Pseudomonas putida Serratia marcescens Staphylococcus epidermidis Streptococcus bovis Risk Group 2 Adenovirus, all types Babesia spp. Bacillus cereus Bordetella spp. Brugia spp. Burkholderia spp. (other than mallei or pseudomallei) Chlamydia spp. Clostridium spp. (other than botulinum) (other than sporogenes) Coxsackie virus Cryptosporidium spp. Dirofilaria immitis Ehrlichia spp. Enterobacter spp. (other than above) Enterococcus faecalis Escherichia coli O157:H7 Escherichia coli (toxigenic other than above) Haemophilus spp. Helicobacter spp. Herpes simplex virus (I and II) Human Immunodeficiency virus Influenza virus Klebsiella spp. Listeria monocytogenes Mycobacterium avium Mycobacterium, BCG Mycobacterium leprae Mycobacterium spp (other than those above and M. tuberculosis) Neisseria gonorrhoeae Neisseria meningitidis Pasteurella spp. Proteus spp. Pseudomonas aeruginosa Salmonella spp. Shigella spp. Sindbis virus Staphylococcus aureus Streptococcus pneumoniae Streptococcus pyogenes Trichuris spp. Vaccinia virus Varicella-zoster virus West Nile Virus Yersinia spp. (other than pestis) Risk Group 3 Bacillus anthracis Brucella spp. Burkholderia mallei Burkholderia pseudomallei Clostridium botulinum Coccidioides immitis Coxiella burnettii Francisella tularensis Hantavirus Mycobacterium bovis (except BCG) Mycobacteria tuberculosis Rickettsia prowazekii Rickettsia rickettsii Yersinia pestis 6 University of Wisconsin Oshkosh Office of Grants and Faculty Development Appendix D: Examples of Toxins of Biological Origin Selected Toxins Toxins of Biological Origin Abrin Aflatoxins Anatoxin Botulinum toxins Clostridium perfringens epsilon toxin Cholera toxin Conotoxins Diacetoxyscirpenol Diphtheria toxin Microcystin Pertussis toxin Ricin Saxitoxin Shigatoxin Staphylococcal enterotoxins Streptococcal toxins Tetrodotoxin T-2 Toxin 7