To:
From:
Date:
Subject:
Northeastern University Institutional Biosafety Committee
Professor
Termination of Biological Safety Registration #
This document serves as a notice of registration termination to the Institutional Biosafety
Committee (IBC).
Identification:
Principal Investigator:
Department:
Registration Number:
Project Title:
Biohazardous Material(s):
Notice of Termination:
I request termination of my registration for work with these biohazardous materials.
Describe how and when the materials will be disposed of:
Certification:
I certify that all materials associated with this registration have been destroyed. I
understand that I must submit a new registration form if I wish to begin using
biohazardous material(s) again.
____________________________________
Signature of Principal Investigator
_______________________________
Date
____________________________________
Signature of Department Safety Officer
_______________________________
Date
Submit this completed form to the Biosafety Program Manager, Office of Environmental
Health and Safety at 170 Cullinane Hall.
IBC Use Only
Date Received: _________________________________
Date Approved: _________________________________
____________________________________
Signature of IBC Chair
_______________________________
Date