Research Integrity &Compliance
Institutional Biosafety Committee
Registration Document for the Storage of Infectious
Agents, Biological Toxins and Recombinant DNA
USF requires that the storage of infectious agents/biological toxins/recombinant DNA at this university be
registered with and approved by the Institutional Biosafety Committee (IBC) prior to acquisition of the
agents. Storage of infectious agents/biological toxins requiring BSL-4 containment is prohibited on the
USF campus. Storage applications are limited to storage (short or long term) of agents that are not
actively being manipulated, used in research or teaching endeavors, but that are being stored for future
use. Prior to use in research or any manipulations of the agent, either a Registration Document For The
Use of Infectious Agents and Biological Toxins OR Registration Document For The Use of Non-Exempt
Recombinant DNA must be submitted, reviewed and approved.
Instructions:
1. Completed forms may be submitted by E-mail to biosafety@research.usf.edu and follow with mailed
hard copies of signature pages bearing original signatures to the Institutional Biosafety Committee,
Research Integrity & Compliance, MDC 35
2. For more information, contact Farah Moulvi at (813) 974-0954 or Debbie Howeth at (813) 974-5091.
3. This storage application cannot be used for Select Agents.
Section 1 Part A – Basic Information
1.A.1
1.A.4
Principal Investigator:
Department:
Building:
E-mail:
Office Phone:
PI’s Study Coordinator:
Coordinator E-mail:
Campus Mail:
Office Room#:
Fax:
Lab Phone:
Coordinator Phone:
Project Title:
Storage Only
Section 2 Part B – Project Information
1.
Infectious Agents and Biological Toxins
1.1
Provide all requested information for each agent/toxin that will be stored in your lab in
table below:
Type Name of
Strain of Agent Source3 Risk
Biosafety Locations
1
2
4
Material
Group
Level4
(if applicable)
of
(RG)
(BSL)
Storage
Item
#
1
P=parasite, F=fungus, B=bacteria, R=Rickettsia, V=virus (not arbovirus), A=Arbovirus, T=toxin,
PR=prions, VR=viroids, O=other. 2 If agent, list genus & species. If toxin, include agent (genus & species) it
is derived from 3 Specify the type and name of source (e.g., vendor – ATCC; off-campus collection – Univ. of
CA; clinical specimen - human) 4 Refer to the NIH Guidelines, and the BMBL for RG and BSL designation.
RCDC 061.1
Registration Document for the Storage of Infectious Agents and Biological Toxins
Rev. 03/13/2014
USF Institutional Biosafety Committee
Page 1
2.
Medical Information
By checking this box, I affirm that in the case of an exposure incident my
laboratory personnel (Faculty, staff, students and visitors) have been instructed to
follow the Exposure Management Plan, as described below:
1.
2.
Contact AmeriSys at 1-800-455-2079 (24 hours a day/7 days per week) --During working hours (M-F, 8 – 5 PM) the USF Worker’s Compensation
Insurance Specialist Meica Elridge should also be contacted at (813) 9745775, or (melridge@admin.usf.edu).
In the event that follow-up is necessary following initial care from the USF
Workers’ Compensation Provider, please contact the USF Medical Health
Administration (Employee Health) office at (813) 974-3163, or pager (813)
216-0153.
Moffitt Personnel:
Moffitt Incidents Website per Moffitt Work Related Injury policy EH-13
3.
Experimental Procedures
By checking this box, I affirm the following:
 The procedures for this agent will be limited to storage and inventory.
 In the case of a spill you will follow USF Biosafety policy spill procedures for
cleanup.
 At such time that disposal of the infectious material occurs it will be
packaged and disposed as biohazardous waste per USF policy.
 Toxin(s) will be inactivated and disposed of. See BMBL 5th Ed.
http://www.cdc.gov/biosafety/publications/bmbl5/BMBL5_appendixI.pdf
4.
Investigator Assurance
 I acknowledge my responsibility to secure and control the biological agents used in this
project.
 I acknowledge that I am trained and aware of the risks and will handle safely.
 I acknowledge that the agents will be stored in a secure area and that the
freezer/fridge/container will be labeled with the Biohazard symbol.
 I acknowledge that prior to use for research or any manipulations of the agent I must
submit and receive approval for either a Registration Document For The Use of
Infectious Agents and Biological Toxins OR Registration Document For The Use of
Non-Exempt Recombinant DNA.
____________________________________________
Signature of Principal Investigator
___________________
Date
RCDC 061.1
Registration Document for the Storage of Infectious Agents and Biological Toxins
Rev. 03/13/2014
USF Institutional Biosafety Committee
Page 1