MEDSTAR HEALTH RESEARCH INSTITUTE
INSTITUTIONAL BIOSAFETY COMMITTEE
Annual Continuation/Termination Form:
Recombinant DNA and Biohazardous Agent Research
Principal Investigator:
Department:
Phone:
E-mail:
Project Title (if applicable):
Funding Agency (if applicable):
Identify Biohazardous Material(s):
IBC approval number:
Please check the appropriate response.
I request continued IRB approval of my use/possession of biohazardous material(s)
described above (Complete sections A-C below, as appropriate)
OR
I request termination of IBC approval (Complete Section C below). Describe when and
how biohazardous material(s) identified above were disposed of:
A. GENERAL INFORMATION
The proposed research is continuing without modification.
The proposed research is continuing with minor modification If so, please explain briefly
below.
Will the principal investigator change?
□ Yes
□ No
Will the Risk Group change?
□ Yes
□ No
Will the Biosafety Level (BSL) change?
□ Yes
□ No
Will the type or amount of biohazardous material(s) change?
□ Yes
□ No
IBC Continuing Review Form, Version 1, 1/23/2012
Will the biohazardous material(s) be moved to another laboratory?
□ Yes
□ No
Will the use of the biohazardous material(s) change?
□ Yes
□ No
NOTE: Please be aware that substantial modifications require a new application. If the answer
to any of the above questions is YES, you must submit an amended IBC application to the IBC
for approval before making these changes.
B. ADVERSE EVENTS
Have any adverse events occurred since the IBC approval or last request for continuation?
□ Yes
□ No
If so, was an adverse event form submitted and appropriate federal agencies notified, as
□
required under the NIH Guidelines?
Yes
Please attach a copy of all AE reports submitted.
□ No
C. Certification
I certify that the above information accurately describes the current status of biohazardous
materials that were previously approved by the IBC. I understand that I must resubmit a new
IBC Application form in the event my use of or amount of biohazardous material(s) changes or is
I wish to being using biohazardous materials again.
____________________________________________
Signature of Principal Investigator
_______________
Date
____________________________________________
Signature of Department Chair
______________
Date
Continuation Number: ____________
Biosafety Level: ______________
Signature of IBC Chair: ___________________________
IBC Continuing Review Form, Version 1, 1/23/2012
Date: ________________