Principal Investigator:
Protocol # (if available):
Date:
SECTION F: HAZARDOUS AGENTS USED IN ANIMALS
Note: Protocols involving biohazards or recombinant materials cannot be approved without DES risk assessment
and appropriate registration(s), approval(s) and supporting documentation (see below, F1b).
F1. HAZARDOUS AGENTS
a. Hazard type Check all that apply to this protocol.
Human/NHP blood, cell culture or
unfixed tissue *
Toxicological agents *
Agents infection plants, animals
and/or humans (i.e. bacteria, virus,
prion) *
Other hazardous chemicals
Radioactive materials
Laser / irradiator / x-ray machines
Research involving recombinant or
synthetic nucleic acid (rDNA)
molecules *
Generation, purchase or use of transgenic
animals *
Carcinogens / mutagens
Caustic agents
Other:
*
Other:
May require IBC registration and/or approval.
Please refer to: http://www.des.umd.edu/general/committee/ibc/index.html
b. Registrations and approvals
Approval Type
Approval #
IBC
Radiation Safety
Other
Registration not required
Approval Date
Approval Expiration Date
c. Documentation Mark an “X” in applicable box(es):
IBC approval letter(s) issued by DES has/have been
uploaded to IRBnet.
AGENT-SPECIFIC TRAINING Document has been uploaded
to IRBnet. PI must place a copy of this document in the
applicable animal room(s).
N/A
N/A
All chemicals are covered under Chemical Hygiene Plan.
All hazard-specific training required is included on the Personnel Qualifications Form (PQF).
F2. HAZARDOUS AGENT USE (copy and complete a separate, additional F2 for each agent; please list
specifics, e.g., strain, gene, cell line, etc.)
a. Administration of agent / materials
Hazard
e.g., Infectious agent,
human/NHP materials, rDNA
Dose & Frequency of
Administration
Route of
Administration
Duration of
Treatment
b. Non-biohazards (for biohazards, see F2c, below)
Containment (describe):
Personnel protective precautions (describe):
Length of time the agent remains a threat to animals or humans working with animals:
c. Biohazards
Containment level Mark an “X” in applicable box(es)
ABSL-1
Personnel protective precautions (describe):
ABSL-2
ABSL-3
Will biosafety cabinets or dump stations be used?
Yes.
Type of equipment:
Location:
Date certified:
Will animals be housed in primary containment?
Yes.
Type of
equipment:
Location:
Date certified:
Means of caging and equipment decontamination. Describe:
Method of animal waste and bedding decontamination before disposal. Describe:
Method of animal carcass disposal. Describe: