Georgia Institute of Technology
IBC Application for Georgia Tech Personnel Working at Off-Campus Site(s)
Instructions
Georgia Tech Personnel Working at Off-Campus Site with OBA-Registered facility
In cases where the Georgia Institute of Technology (GIT) faculty member or student is involved in work located at an
off-campus site with an Office of Biotechnology Activities (OBA) registered Institutional Biosafety Committee (IBC),
the GT IBC may accept an approval statement from that other IBC, in lieu of performing a duplicate review. However,
the GT IBC requires investigators to submit a copy of the IBC approved application from the other reviewing
institution, a copy of that institution’s IBC approval letter along with this application below.
Georgia Tech Personnel Working at Off-Campus Site without OBA-Registered facility
The current GT IBC application process must be followed.
Required Training
In accordance with the NIH Guidelines, Section IV-B-1-h, the Institutional Biosafety Committee requires that all
personnel named in recombinant DNA (rDNA) registrations complete certain training. New rDNA registrations,
revision requests, and continuing review applications will be screened by the Office of Research Integrity Assurance
(ORIA) to ensure that all personnel have completed the training requirement before committee approvals will be
issued. For further details, please visit: http://ibc.gatech.edu/requirement-completion-rdna-training-through-ehs
Enroll In Occupational Health Program (OHP)
The institution where the research will be conducted may have additional OHP requirements. Everyone named on the
protocol must enroll in the GT OHP, managed by Environmental Health & Safety:
http://www.ehs.gatech.edu/occupational/
Departmental Sign Off
This prepared IBC application is to be signed by the applicant’s department head or, in lieu of a written signature,
department heads may send an email to ibc@gatech.edu stating that they are aware of the proposed work and concur
with its submittal to the IBC.
For assistance, contact the Office of Research Integrity Assurance www.ORIA.gatech.edu or www.IBC.gatech.edu.
Note: The above instructions may be deleted before submitting this application to the IACUC.
Georgia Institute of Technology
Office of Research Integrity Assurance
IBC IBC@gatech.edu
IBC Application for Off-Campus Studies
September 2014
Page 1
Georgia Institute of Technology IBC Application
for Georgia Tech Personnel Working at Off-Campus Site
A. Administrative Data
GT Principal Investigator / Course Director:
Department:
Telephone:
Emergency Contact and Contact #:
Project Title:
Funding Source:
Office of Sponsored Programs (OSP) Number (Doc ID or Project number):
Off-Campus Institution:
Off-Campus PI:
Off Campus Registration #:
B. Personnel, Training and Qualifications
The institution where the work will be conducted may have additional training and Occupational Health
and Safety requirements. All GT personnel must complete the training and Occupational Health and Safety
requirements as described in Section D below (also on the GT IACUC website).
Principal Investigator:
Training plan or qualifications:
C. Study Objectives
If your study is only part of the approved IBC Registration at another institution, please state what part of
the research you and your research team will be involved in. If you will be involved in the full research
protocol approved at another institution just state “full protocol.”
D. Certifications and Signatures
TRAINING: All Principal Investigators, Co-Investigators, and students involved in this IBC Registration
must complete training in accordance with the NIH Guidelines, Section IV-B-1-h. For further details, please
visit: http://ibc.gatech.edu/requirement-completion-rdna-training-through-ehs
OCCUPATIONAL HEALTH AND SAFETY: Enrollment in the Occupational Health Program is also
required for all personnel involved in research involving vertebrate animals and who handle biological
materials or chemicals or are exposed to other health risks. Information regarding the completion of The
Confidential Exposure/Risk Assessment Questionnaire form and the Occupational Health Program is
available at: http://researchintegrity.gatech.edu/about-iacuc/occupational-health-program/.
Georgia Institute of Technology
Office of Research Integrity Assurance
IBC IBC@gatech.edu
IBC Application for Off-Campus Studies
September 2014
Page 2
Certification: I have read and am familiar with the standard and special microbiological practices,
containment equipment, personal protective equipment, and laboratory facilities recommended for the
biosafety level applicable to this project. I will ensure that all faculty, staff, and students working on this
project will follow these recommendations as a condition of Institutional Biosafety Committee approval of
this project.
Certification: As Principal Investigator, I acknowledge responsibility for this project and assure that the
faculty, staff and students who participate in it are qualified and adequately trained to conduct the above
research.
Signature of Principal Investigator: __________________________ (PI may submit via GIT email for esignature)
Departmental Signoff
Name of Department Chair:
Signature of Department Chair: __________________________ (Chair may submit via GIT email for esignature)
Georgia Institute of Technology
Office of Research Integrity Assurance
IBC IBC@gatech.edu
IBC Application for Off-Campus Studies
September 2014
Page 3