1. Please complete this form and submit electronically to ubc@griffith.edu.au
2. Refer to the information sheet or follow hyperlinks for help completing this form.
3. Some explanatory text and examples are provided in orange italics .
4. Further guidance on the completion of this form can be obtained by emailing ubc@griffith.edu.au
Click here to access the UBC website
SECTION 1.0: TYPE OF HIGH RISK BIOLOGICAL WORK
Check
Box
Indicate which type(s) of High Risk Biological Activity being undertaken or proposed.
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Activities involving Risk Group 2 microorganisms * which require
‘ special precautions ’
Activities involving Risk Group 2 Microorganisms * cultured in large volumes (
≥10L)
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Activities involving infectious or potentially infectious animals, tissues or fluids
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Activities involving unscreened specimens
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Activities involving poisonous or venomous animals
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Activities involving Biological Toxins
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Activities involving Biological material on the Defence Strategic Goods List (DSGL)
Activities involving security sensitive biological material (SSBA’s)
Other; please give full details below
* as listed in AS2243.3 2010, Section 3 or any microorganism categorised as Dangerous Goods Class 6.2 (Infectious
Substances) or those falling under UN2814 & UN2900 in the Dangerous Goods Regulations (IATA).
SECTION 2.0: PROJECT/ACTIVITY LEADER INFORMATION:
Project/Activity Supervisor:
Group
School:
Research Centre:
Campus:
Business Hours Contact Number:
Email Address:
Relevant Experience/Qualifications:
Completion date of last Griffith University
Biosafety Training
(e.g. Health Group, Griffith Sciences or other)
(if applicable)
(e.g. Nathan, Gold Coast, MtGravatt, or Logan)
(e.g. length & type of experience/qualifications)
Reviewed October 2014
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What are the class of people authorised to undertake work associated with this project/activity:
Name of Operations/Laboratory Facility Manager to be informed of activity:
Name(s) of key staff &/or students working on project or supporting activity
(name)
(e.g. Research fellow, senior scientist, research assistant, technical officer, PhD student, Honours student, Undergrad student)
(if applicable)
Outline the training and experience of staff and students
(e.g. Biosafety Training/Induction BSc Hons PhD)
Note: Subsequent changes to the staff/students working on the project/activity are to be managed locally.
It is the responsibility of the project/activity supervisor to ensure all participants have appropriate training and experience.
SECTION 3.0: PROJECT/ACTIVITY INFORMATION:
Project/Activity Title:
Anticipated
Commencement Date:
(or indicate as existing)
Expected Completion Date: (maximum length of a registration is 5 years)
Briefly describe the project/activity, including the purpose and aims. Please limit your answer to half a page
Please describe the nature of the project/activity including associated experimental procedure if relevant
Provide a list of the material/species classified as high risk involved in the activity (include common and scientific names, if applicable)
Risk Group
(if applicable)
(description/genus/species)
ATCC# or strain ID
(if applicable)
(PC2+/ PC3)
If applicable has the project already been submitted for approval to the
Animal or Human Ethics Committee?
If applicable please provide your ethics reference number, date of approval and date of expiry:
(E.g. Yes to AEC & HREC)
Ref:
Approval:
(E.g. MSC/01/13/AEC)
(E.g. 7/2/13)
Expiry: (E.g. 7/2/16)
Reviewed October 2014
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SECTION 4.0: ASSESSMENT AND RISK MANAGEMENT:
Please note that approval of this registration is dependent on the inclusion of a suitable risk assessment.
A risk assessment that addresses the risks relating to people, activity/procedures, facilities, equipment, chemicals, storage and transport MUST be submitted with the registration form. It is preferred that the risk assessment is completed using GSafe.
What are the main risks to individuals from the proposed activity directly relating to the high risk biological material?
(i.e. Consider hazards, consequences and likelihood)
What are the main risks to the environment or community from the proposed activity directly relating to the high risk biological material?
Provide details of disposal methods of high risk biological materials: undertaking the dealings.
E.g. High risk of laboratory acquired infection.
This relates to the occupational health and safety of people
This relates to other people or the environment that may be exposed to a biological hazard that is unintentionally released.
E.g. Medium risk to the community.
Are the materials being transported between facilities or off campus?
This includes arrangements for disposing of liquid and solid waste from the activities and for disposing of the carcasses of all animals inoculated with microorganisms.
If yes, please indicate why it will be required and how it will be transported .
What are the steps you will take in the event of an unintentional release of the high risk biological material?
Include here spills procedures for liquid spills and plans to deal with the escape of any animals to be used during the proposed activities.
Attach a risk assessment of the proposed activities outlining possible hazards and proposed controls. Please include details of any health surveillance and vaccination considerations of applicable. If dealing with biotoxins, provide details of stock concentrations as well information on lethal doses in vertebrate (LDL), as well as safety data sheet (SDS), if available.
Please submit a copy of the risk assessment with this registration form.
SECTION 5.0: FACILITIES USED:
Primary Dealing Location Campus: Building: Level.Room(s): .
Containment
Level:
Name of Laboratory
Facility Contact/Mgr:
Primary Storage Location Campus: Building: Level.Room(s): .
Containment
Level:
Name of Laboratory
Facility Contact/Mgr:
Secondary Dealing
Location
Containment
Level:
Campus:
Name of Laboratory
Facility Contact/Mgr:
Building: Level.Room(s): .
Containment
Level:
Secondary Dealing
Location
Campus:
Name of Laboratory
Facility Contact/Mgr:
Building: Level.Room(s): .
Reviewed October 2014
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SECTION 6.0: DECLARATION OF COMPLIANCE:
I declare that this project/activity involving High Risk Biological dealings will be at all times conducted in accordance with the controls outlined in the risk assessment, the University’s Health and Safety policies and any other conditions or requirements imposed by the Griffith University Biosafety Committee.
I declare that to the best of my knowledge, having made reasonable inquiries, the information herein is true and correct. (electronic signature or email title accepted)
Signature of Project/Activity Supervisor:
Date:
School/Res Centre/Faculty Recommendation
Signature Head of School/Director/or Dean
Date:
Comments (if applicable):
For new projects/activities you must not commence the high risk dealing until written endorsement from the UBC is provided.
Please email the completed Registration Form and any supporting documentation to the Griffith University
Biosafety Committee at ubc@griffith.edu.au
SECTION 7.0: UBC EVALUATION:
(This section is to be completed by the UBC)
UBC HRBD Identifier:
Version Number:
This reference number will be advised upon receipt of registration form.
The version number will be updated by the UBC after each edit/draft
Date of UBC approval:
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A comprehensive Risk Assessment has been provided and suitable controls have been outlined.
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The project coordinator/supervisor has confirmed all participants will have appropriate training.
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The project/activity has been approved by the School, Research Centre or Faculty.
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The UBC has evaluated this application for registration and does not endorse the commencement of the project/activity.
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The UBC has evaluated this application for registration and endorses the commencement of the project/activity.
Griffith University Biosafety Committee
Evaluated by:
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Reviewed October 2014