Health, Safety
& Environment
Research Involving Recombinant DNA and Genetic Manipulation
(Appendix 7 of Biosafety Program)
Principal Investigator
Name:
Department/Unit:
Office Phone:
Email:
1.
Vector used (plasmid/phage/virus):
2.
a) Prokaryotes (e.g. E. coli K12):
b) Eukaryotes (e.g. mammalian cell line):
c) Higher animals (e.g. mice)
3.
Source of cloned DNA
(host organism/gene name of nature of sequence):
4.
Risk Group level of source organism:
And Host:
5.
Will experiments involve
a) DNA transfer to animals?
Yes
No
b) DNA transfer to plants?
Yes
No
c) Genetic alteration of animals?
Yes
No
d) Genetic alteration of plants?
Yes
No
e) Expression of cloned DNA?
Yes
No
f) Release of rDNA/genetically altered animals or plants to the environment?
Yes
No
Briefly describe the research (1-2 sentences).
 Include and describe the hazards that may be associated with this research (e.g. the replication competency of
the recombinant organisms, the potential pathogenic or non-pathogenic properties of the protein expressed
by the recombinant techniques, the process used to identify the hazards and assess the risks of infectivity,
allergenicity, toxicity or other hazardous properties [e.g. antibiotic resistance] of the GMO to workers).
Please submit completed form: by mail to Health, Safety & Environment, Human Resources
or, by e-mail to health.safety@uregina.ca
2012-03