Texas A&M University-Kingsville
Institutional Biosafety Committee
Office of Research and Sponsored Programs: (361) 593-3344 or osr@tamuk.edu
Recombinant DNA and Artificial Gene Transfer Form
1.
Gene Transfer
1.1 Gene Transfer will involve (check and describe):
Physical methods (e.g., pronuclear injection, electroporation, “gene gun”, etc)
Describe:
Host-Vector system
Vector used:
Other
Describe:
1.2 List genetic material to be transferred (e.g., genes, DNA or RNA)
Genes, DNA or RNA
Species of Origin
Function of Gene
1.3 Describe the vector(s), including any regions that increase the biological safety of the
construct.
1.4 Explain the host range of each vector (e.g., is the vector amphotropic, ecotropic, is the vector
pseudotyped?)
1.5 Provide scientific rationale for using the vector(s) proposed.
1.6
2.
Attach a map of each vector.
NIH Guidelines Experiment Designation
The IBC will designate the section(s) of the NIH Guidelines for Research Involving Recombinant
DNA Molecules under which these experiments are covered (e.g., III-D-1-a, III-E, etc).
If you would like to suggest a designation, please refer to the NIH experiment classifications
described in Section III (pages 14-20) of the NIH Guidelines. Please note Texas A&M
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University-Kingsville policy requires that all rDNA and artificial gene transfer activities
are approved by the IBC prior to initiation.
Section(s): IIIThe TAMUK IBC has developed a summary of the experiments covered by the NIH Guidelines.
See Appendix A located on the ORSP website at http://www.tamuk.edu/osr/forms.html .
3.
Biosafety Levels
3.1 Indicate the biosafety level in the laboratory where activities will be performed.
BSL1
BSL2
Location (physical location):
3.2 If animals are used, indicate the biosafety level in which they will be housed.
No animals
ABSL1
ABSL2
Location of animal housing (physical location):
4. Use of a Biosafety Cabinet
Will work be conducted in a biosafety cabinet for these activities?
No
Yes
If yes, what is the date of certification?
5. DNA Clones
Do the DNA clones contain genes for the biosynthesis of toxic molecules lethal for vertebrates?
No
Yes
If yes, provide documentation in the Biological Toxins Usage Form.
6. Volume of Culture
Do individual activities involve more than 10 liters of culture?
No
Yes
If yes, provide location (room and building):
7. Environmental Release
Do activities involve the release of an organism containing rDNA into the environment?
No
Yes
If yes, approval of the release must be requested from the state or federal regulatory
agency.
Agency:
Date filed:
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Attach a copy of the permit. IBC approval cannot be granted until permit is
received.
8. Laboratory Procedures
8.1 Experimental activities
Provide a summary of the laboratory activities that will be conducted.
8.2
Standard Operating Procedures
Attach detailed Standard Operating Procedures for the experimental activities
described above.
8.3
Potential Hazards and Safety Procedures
Identify potential exposure hazards during sample preparation and experimental
manipulations. Examples: aerosol generation when transferring, mixing and/or
centrifuging, use of sharps, excretion by animals, culturing, etc.
Describe the safety procedures and safety equipment used to minimize risk and prevent
release of infectious agents for each potential exposure hazard, e.g. lab coats, gloves, face
shield, biological safety cabinet, secondary containment for liquids, spill mats, secondary
containment for centrifuge samples, etc.
Potential Hazards
Safety Procedures
8.4 Waste disposal
Attach the Waste Disposal Plan (available on OSR website:
http://www.tamuk.edu/osr/forms.html ). Call the Environmental Health and Safety Office for
information about waste disposal: (361) 593-2646 or (361) 593-4131
8.5 Decontamination and Spill Clean-up
Attach the Decontamination Plan (available on OSR website:
http://www.tamuk.edu/osr/forms.html ), including the sections entitled “Lab Specific
Requirements”. The plan must be customized for your laboratory.
You have reached the end of this form. Please make sure that you have responded to every question on
this application (even if your response is “not applicable”) .
Save an electronic copy of this completed form and submit to osr@tamuk.edu. You will receive an
electronic message from the Research Compliance Liaison within 2-3 days acknowledging receipt of
your submission.
Submit to:
Research Compliance Liaison
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Email as PDF to: OSR@tamuk.edu
Mail Code: MSC 201
Fax: 361-593-3409
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