Division of Research Integrity &Compliance Institutional Biosafety Committee Registration Document for the Use of Infectious Agents and Biological Toxins USF requires that all projects involving the use of infectious agents or biological toxins conducted at or supported by this university be registered with and approved by the Institutional Biosafety Committee (IBC) prior to initiation of the project. If you are using infectious agents / biological toxins requiring BSL-3 containment, contact Farah Moulvi, Institutional Biosafety Officer, at (813) 974-0954 for further instructions. The use of infectious agents/biological toxins requiring BSL-4 containment is prohibited on the USF campus. Instructions: 1. Provide complete information for every item. Blank or incomplete items may delay the processing of your application. 2. Consult the following reference materials prior to filling out this form. These can be accessed through our website at: http://www3.research.usf.edu/dric/biosafety/default.asp a. Biosafety in Microbiological and Biomedical Laboratories, 5th Edition, J. Y. Richmond and R. McKinney, Editors (on reserve at the Tampa campus library and Health Sciences Center library) b. Material Safety Data Sheets (MSDS) for Infectious Agents c. Risk Group Classification for Infectious Agents d. USF Institutional Biosafety Manual: 3. 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. Mail to Farah Moulvi, Institutional Biosafety Officer, Division of Research Integrity & Compliance, MDC 35 BSL-2 or BSL-3 laboratories must pass inspection before initial approval for research activities can be granted for this proposed study. The Principal Investigator is responsible for scheduling an inspection by contacting the Biosafety staff at biosafety@research.usf.edu or (813) 974-5091 or (813) 974-5110. 4. For more information, contact Farah Moulvi at (813) 974-0954 or Debbie Howeth at (813) 974-5091. Section 1 Part A – Basic Information 1.A.1 1.A.2 1.A.3 Principal Investigator: Department: Building: E-mail: Office Phone: PI’s Study Coordinator: Coordinator E-mail: Type of Registration: Single Project Campus Mail: Office Room#: Fax: Lab Phone: Coordinator Phone: Multi-Project Please check one: New Registration 3rd Year Renewal Registration Replacing Previous IBC Study # RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 1 1.A.4 Project Title(s) (if multi-project, list titles of each project and assign a number to each): 1.A.5 Sponsor(s)-List intramural and/or extramural sources: Part B – Project Information 1.B.1 Describe your research objectives in lay terminology (1 to 2 paragraphs): 1.B.2 Provide below or attach a one-page description of the research project including in vitro and/or in vivo specific laboratory procedures (e.g., culturing, vortexing, incubating, etc) that will be performed during the study. Detail the actual physical manipulations with special attention towards the safe handling of the infectious agent(s) and/or toxins and include any animal and/or animal tissue handling procedures during the experiment. (For example: "All pipeting will be performed in a BSC will non-aerosolizing tips." Or "Centrifugation will be performed only on tightly-capped sample vials in a rotor equipped with safety centrifuge caps.") RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 2 2. Infectious Agents and Biological Toxins 2.1 Item # Type 1 Provide all requested information for each agent/toxin that will be used in this project in table below: Name of Material2 Strain of Agent (if applicable) Source3 Risk Group4 (RG) Biosafety Level4 (BSL) Locations of Use Locations of Storage (if different) Maximum amount possessed (volume or weight) Maximum concentration to be used (e.g pfu/ml) 1 2 3 4 5 6 7 8 9 10 1 2 3 4 P=parasite, F=fungus, B=bacteria, R=Rickettsia, V=virus (not arbovirus), A=Arbovirus, T=toxin, PR=prions, VR=viroids, O=other. If agent, list genus & species. If toxin, include agent (genus & species) it is derived from. Specify the type and name of source (e.g., vendor – ATCC; off-campus collection – Univ. of CA; clinical specimen - human) Refer to the NIH Guidelines, and the BMBL for RG and BSL designation. RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 3 2.2 Indicate the Biosafety Containment Level (BSL) if different than the BSL specified in Table 2.1: BSL-1 BSL-2 BSL-3 Provide justification for the difference: 3. Regulated Agents 3.1 Are any of the infectious agents / biological toxins (virulent or attenuated) in this application listed in Appendix A - Regulated Agents? No. Go to Section 4. Yes. Notify the Institutional Biosafety Officer immediately at (813) 974-0954 to insure compliance with all federal mandates. 3.2 Have you registered the agents/toxins as select agents with the CDC/USDA? No. Explain the exemption/exclusion criteria. Yes. Explain the status of the CDC/USDA select agent registration/certificate for this project: Submit a copy of CDC/USDA registration: A. Describe the specific security procedures that you will use to ensure secure (a) access, (b) use, (c) storage, and (d) disposal: B. Describe the inventory control system for the agents/toxins you plan to use (e.g., procedures used to account for the agents and to detect missing material): 4. Recombinant DNA Technology 4.1 Do you plan to use an infectious agents generated by recombinant DNA technology? Note this registration application is required for mutant infectious agents. For infectious agents that are replication impaired used as a viral vector use the recombinant DNA registration. No. Go to Section 5. Yes. Describe the recombinant infectious agent including an assessment of the expected phenotype below RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 4 4.2 Will the recombinant infectious agent be generated as part of this study? No. It will be obtained from the following source below . Yes. If yes, also complete the applicable rDNA registration application 5. 6. Human Use 5.1 Will human subjects and/or human clinical specimens be used in any aspect of the experiment? No. Go to Section 6. Yes. 5.2 Has this research protocol been approved by the IRB? No. Date of Intended Submission to IRB: ________________ Yes. IRB study #: ________________ Date approved: ________________ Approval Pending; Date Submitted to IRB: ________________ 5.3 Will you administer infectious agents/biological toxins to humans? No. Yes. Submit copies of the following documents: A. Informed Consent form B. USF Institutional Review Board (IRB) application or IRB approval of exemption C. Sponsor’s investigational brochure D. Protocol 5.4 Does the study involve the use of human cells and/or human clinical samples? No. Yes. List the type of human clinical sample(s) you plan to use: Animal Use 6.1 Will you administer infectious agents/biological toxins to animals or animal tissue in the vivarium? No. Go to Section 7. Yes. Specify the animal species: ________________. 6.2 Indicate the Animal Biosafety Containment Level (ABSL) at which the project will be conducted in the vivarium: ABSL-1 6.3 RCDC 002.12 Rev. 04/2014 ABSL-2 ABSL-3 Has this research protocol received USF Institutional Animal Care & Use Committee (IACUC) approval? No. Date of Intended Submission to IACUC ________________ Yes. IACUC study #: ________________ Date approved: ________________ Approval Pending; Date Submitted to IACUC: ________________ Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 5 6.4 List the animal facility (e.g., College of Medicine, Moffitt Cancer Research, VA Hospital, College of Public Health, LSA, SCA, SRB, ACH, IDRB) and the area/room number (s), if known, where the animals will be housed or used: 6.5 Will the animals exposed to the infectious agents/biological toxins be transported within the animal facility or to other areas within USF: No. Yes. Describe how and where the animals will be transported. 6.6 6.7 Route of agent administration: Intravenous Intraperitoneal Other: [Specify] Subcutaneous Intramuscular Will the infectious agents/toxins present any risk of exposure to animal care staff? No. Go to Section 7. Yes. Answer parts A, B, C and D. A. What animal sources/routes (e.g., urine, feces, blood, bite/scratch), present a potential risk of exposure to the animal care staff? B. What Personnel Protective Equipment is required to be worn by the animal care staff to protect them from potential risk of exposure from the animal source(s) mentioned in part A? Check all that apply. Face masks: N 95 (HEPA) Face Shield Safety Glasses/Goggles Lab Gown Tyvek/Disposable Suits Lab Coats Surgical Mask N 100 (HEPA) Head Covers Double Gloves Gloves Shoe Covers Other: [Specify] C. What safety practices are in place to protect the animal care staff from potential risk of exposure from the animal source(s) mentioned in part A? RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 6 D. The IBC requires a minimum concentration of 10% bleach solution as the primary disinfectant. If using 10% bleach solution as the primary disinfectant check this box. 10% Bleach Solution (1:10 dilution of standard household bleach (5.25% sodium hypochlorite) to water. This needs to be made fresh at least weekly and preferably stored in opaque containers.) If using an alternative disinfectant, specify in box below, the name, active ingredient, concentration and an exemption for use of this disinfectant. NOTE: Unless noted above on this application with an explanation and approved by the IBC, all other disinfectants (e.g., 70% alcohol) are secondary disinfectants to be used after the 10% bleach. 7. Medical Information 7.1 Are there any risks of disease and/or adverse effects (Ex. - Altered immune response/ immunosuppression/allergenicity/toxicity) to humans, animals, and/or plants that might result from exposure to these organisms/toxins? No. Yes. Describe the potential adverse effects to humans, animals, plants, and/or the environment for each infectious agent/biological toxin, including: a. The infectious dose and/or the LD50; b. Availability of treatment or prophylaxis/vaccine (licensed or IND) c. Known drug/vaccine resistance or prophylaxis failure rate (Please note the specific antimicrobial or other agent to which there is resistance); d. The symptoms/disease(s) which may result from exposure. Note: The information needed can be found in the MSDS available at the following website http://www.phac-aspc.gc.ca/msds-ftss/index-eng.php 7.2 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 If you have a protocol specific exposure management plan which is different than RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 7 above, describe in the space provided below. 7.3 Describe the process that will be used to inform the personnel working with infectious agents/toxins of the potential hazards, including the presence of an immunological condition that could increase the risk of infection (e.g., signage on the door, specific training, read and initial this application, etc.). Occupational Health Requirements 7.4 Indicate the Occupational Health Requirements for personnel who will be actively taking part in this research project (check all that apply): Not Applicable Baseline Serum Banking - This is suggested for any disease process potentially found in the community that is most effectively treated by monitoring a rise in serum antibody titer(s). Baseline Status Testing - This is suggested for any disease process potentially found in the general community and is also the focus of this research. The current, appropriate exposure/infected/immune status of the individual(s) will be determined. General Vaccine(s) (Hepatitis B, Influenza, etc.) - Hepatitis B vaccination is recommended for any individual working with human tissue. Additional, appropriate vaccines may be available, depending upon the research agent. Agent Specify Vaccine –specify in box Respiratory Health Evaluation and Respirator Fit-Testing – Respirator (N-95, N100, etc.) use is recommended when there is the possibility for infectious aerosol exposure and/or potentially toxic chemical inhalation exposure during the conduct of this research project. Other [Specify] 8. Experimental Procedures 8.1 Will any of the procedures described in the protocol result in acquisition of a new characteristic, such as enhanced virulence, infectivity, drug resistance, or change in host range? No. Yes. Explain: 8.2 Does the study involve the generation or use of more than 10 liters of culture? RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 8 No. Yes. Explain the culture procedures, including identification of: (a) The culture room. (b) The types of equipment used for culture growth/handling. (c) Any special precautions to handle such large volumes. 8.3 Indicate the types of experimental manipulations which you will use that have the potential to generate aerosols/splashes (check all that apply): Homogenization Centrifugation Sonication Dissection Pipetting Other: [Specify] Cell sorter and or Flow cytometry None. Safety Precautions 8.4 Indicate the Safety Equipment you will use (check all that apply). Stomachers Safety blender (e.g. shatter proof jar-double walled; blender rotors leak proof) Low aerosolization pipette tips Mechanical or electronic pipettors Chemical fume hood (for biological toxin use) Centrifuge with safety cups or sealed rotors heads Other: [Specify] Use of Sharps 8. 5 Indicate the safety practices to be used with Sharps (needles, scalpels, etc.) Substitute glassware with plastic ware, when possible Do not bend, break or recap needles Do not bend, break or recap scalpels Dispose of sharps in red Sharps containers Use of safer sharp devices/engineered sharps Not Applicable NOTE: An engineered sharp has a physical attribute built into the sharp device that effectively reduces the risk of an exposure incident. Examples of such devices include retractable needles, hinged needle shields, needless IV connectors, sliding sheath/sleeve and needle guards). For a list of Safety-Engineered Sharp Devices and other products designed to prevent occupational exposures 8.6 RCDC 002.12 Rev. 04/2014 Do you intend to use a Biological Safety Cabinet (BSC)? No. Explain what safety procedures you will use instead of the BSC to eliminate the risk of aerosols exposures: Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 9 Yes. Answer A: A. BSC must be certified annually. Provide the date of the last certification: [Specify] 8. 7 Indicate the Personnel Protective Equipment that will be used (check all that apply): Particulate respirators: N 95 (HEPA) N 100 (HEPA) Face Shield Double gloves Safety Glasses/Goggles Gloves Lab coats (front buttoned) Lab gown (Tie backs) Disposable Suits/coveralls with attached hood and boots Other: [Specify] NOTE: The use of particulate masks such as N-95 requires medical evaluation, fit testing and training prior to its use per OSHA regulations. 8.8 Have all personnel working with infectious agent(s) been instructed and trained in lab-specific clean up procedures for biohazardous spills (that is both USF Biosafety Training Course and PI provided training)? No. Yes. NOTE: For general biohazard spill procedures access following website http://www3.research.usf.edu/dric/biosafety/resources.asp . Print and post the Biological spill response in the laboratory. 8.9 As part of the research procedures will the organism/toxin be inactivated/lysed before subsequent manipulation outside containment? No. Yes. Answer parts A, B, and C: A. Method of inactivation (heat, chemical, other) B. At what stage of the experiment will the agent/toxin be inactivated/lysed: C. Will you verify inactivation/lysing and if so how? RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 10 8.10 The IBC requires a minimum concentration of 10% bleach solution as the primary disinfectant. If using 10% bleach solution as the primary disinfectant check this box. 10% Bleach Solution (1:10 dilution of standard household bleach (5.25% sodium hypochlorite) to water. This needs to be made fresh at least weekly and preferably stored in opaque containers.) If using an alternative disinfectant, specify in box below, the name, active ingredient, concentration and an exemption for use of this disinfectant NOTE: Unless noted above on this application with an explanation and approved by the IBC, all other disinfectants (e.g., 70% alcohol) are secondary disinfectants to be used after the 10% bleach. 8. 11 Indicate how biohazardous solid waste will be decontaminated and disposed. Autoclaved Time: [Specify] minutes Temp: [Specify] Celsius (for example greater than equal to 121°C and greater than equal 45 minutes) Packaged as biohazardous waste per USF policy Other: [Specify] 8. 12 Indicate how biohazardous liquid waste will be decontaminated and disposed. Autoclaved Time: minutes Temp: Celsius Chemically inactivated: [Specify] Other: [Specify] 8.13 If using a toxin(s), describe how the toxin(s) will be inactivated and disposed. In addition provide documented literature regarding the effectiveness of the inactivation procedure. Storage and Transport 8.14 Will any of these agents/toxins be transported or transferred outside of the room in which they are stored? No. Yes. Answer A and B below: A. To what location(s) outside of your laboratory will you transport/transfer these agents/toxins? B. When transporting/transferring materials the materials must be placed inside a watertight primary container, which is then placed into a watertight, leak proof and durable secondary container for transportation, with absorbent material placed between the two containers to absorb contents of the container in case of possible spill. I will transport material in accordance with the above described procedure. RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 11 8.15 Will any of these agents/toxins be shipped via commercial carrier (e.g., Federal Express)? No. Yes. Identify the person(s) that will be preparing the agents/toxins for shipping and provide their Transportation of Dangerous Goods training dates. 8.16 Will any of these agents/toxins be imported from or exported to one or more foreign countries? No. Yes. All shipments must meet federal and state transportation regulations and USF policies. Respond to A, B, C, and D below: A. List the agents/toxins to be imported and/or exported. B. List the country of origin or destination for each. C. Indicate whether this is a one-time shipment or part of a series of shipments. D. Attach a copy of the USDA permit. 9. Diagram of Laboratory Areas 9.1 RCDC 002.12 Rev. 04/2014 Attach a clearly labeled diagram of the laboratory that shows the following: 1) Where the agent(s)/toxin(s) will be manipulated and stored; 2) Location of biological safety cabinets, eye-wash, sink, and other equipment (such as centrifuge, incubators, freezers, cell sorters etc); 3) Room entry/exit; 4) Location of the nearest available autoclave (if autoclave is not available in laboratory, list the location using text). Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 12 10. Personnel The Institutional Biosafety Committee (IBC) must be notified of any new personnel who will be directly involved in the conduct of the experiment and/or for whom a potential risk exists by virtue of their presence within the research environment. 10.1 List the names of all personnel involved and have each person initial the following assurance: I have read and understand the nature of these experiments. I have the knowledge and training required to safely handle the materials described. I agree to conduct these experiments in accordance with all USF IBC policies and the USF Biosafety Manual: http://www3.research.usf.edu/dric/biosafety/docs/biosafety-manual.pdf I have attended/will attend the annual USF biosafety training indicated. Name Initial here Date Biosafety Training* Training Date E-mail Occupational Health Evaluation Completed Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA Yes No Yes No NA *The following types of training classes are required: Core – Must be completed by those who have not completed it previously. Continuing Education – Must be completed annually. Special Topics – Required for persons involved in certain types of work. For current Biosafety training information, go to: http://www3.research.usf.edu/dric/biosafety/education.asp RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 13 11. Laboratory Inspection BSL-2 or BSL-3 laboratories must pass inspection before initial approval for research activities can be granted for this proposed study. The Principal Investigator is responsible for scheduling an inspection by contacting the Biosafety Staff at biosafety@research.usf.edu or (813) 974-5091 or (813) 974-5110. Information on biosafety containment levels and other guidance is available in the NIH Guidelines for Research Involving Recombinant DNA Molecules, the Biosafety in Microbiological and Biomedical Laboratories, 5th Edition , and the USF Institutional Biosafety Manual. Investigators are encouraged to consult these sources to ensure that their laboratories meet the required standards for sound biosafety practices. A Sample BSL-2 Checklist is provided to help you prepare for a laboratory inspection. 11.1 Has your laboratory been scheduled for inspection? Yes. Provide the date: No. Inspection is pending due to: Does not apply because the laboratory involved is BSL-1. 12. Investigator Assurance I agree to use lab practices that meet the highest biosafety level (BSL) specified in Table 1.1 with all work with infectious agents/biological toxins in this project. I have read the Biosafety in Microbiological and Biomedical Laboratories, 5th Edition and I acknowledge my responsibility for the conduct of this research in accordance with the procedures described in it. I have the knowledge and training required to safely handle the materials described. I acknowledge my responsibility for the conduct of this research in accordance with University Policy, Section IV-B-7 of the NIH Guidelines and/or the recommendations of the CDC/NIH published in Biosafety in Microbiological and Biomedical Laboratories, 5th Edition and the USF Institutional Biosafety Manual . I acknowledge my responsibility to secure and control the biological agents used in this project. Entry doors to the laboratory will be closed and locked when the laboratory is unattended. ____________________________________________ Signature of Principal Investigator RCDC 002.12 Rev. 04/2014 ___________________ Date Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page 14 Appendix A – Biosafety References Biosafety in Microbiological and Biomedical Laboratories, 5th Edition Material Safety Data Sheets (MSDS) for Infectious Agents Risk Group Classification for Infectious Agents USF Institutional Biosafety Manual NIH Guidelines for Research Involving rDNA Molecules Biological Spill Response CDC Regulated Agents Appendix B – Response to Laboratory Personnel Bloodborne Pathogen (BBP) Exposure The following emergency response guidelines shall be followed when a laboratory worker has been exposed to potentially infectious agents, including bloodborne pathogens to ensure prompt and appropriate care. BBP Exposure is defined as “A percutaneous injury (a needlestick or cut with a sharp object) or contact of mucous membrane or nonintact skin with blood, tissue or other body fluids that are potentially infectious”. Some post-exposure treatments must be started within 1-2 hours of exposure, so time is critical. If Percutaneous and/or Non-Intact Skin Accidental Exposure Occurs: Secure sharp device in sharps container Wash the exposed site thoroughly with soap and water Remove contaminated clothing Report exposure to supervisor immediately If Mucous Membrane Accidental Exposure Occurs: Flush eyes, nose and/or mouth with copious amounts of water at the nearest faucet or eye wash station. Remove contaminated clothing Report exposure to supervisor immediately If you are exposed to a Bloodborne Pathogen: Immediately report all possible work-related exposures to potentially infectious agents, including BBP’s to your supervisor. Exposures are to be reported immediately by the supervisor or department designee by telephone to AmeriSys 1(800)455-2079 (24 hours a day/7 days per week). During working hours (M-F, 8-5PM) the USF Worker’s Compensation Insurance specialist Meica Elridge should also be contacted at (813) 974-5775 or by email at 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 by pager (813) 216-0153. If you become ill or injured on the job: An employee who becomes ill or is injured as the result of a job-related incident must report the incident to the supervisor immediately no matter how minor the injury may appear to be. Effective January 1, 2009, all work-related injuries or illnesses are to be reported by the supervisor or department designee by telephone to: AmeriSys 1(800)455-2079 (toll free). For additional information on how to report a work-related injury or illness go to the USF Worker’s Compensation website at: http://usfweb2.usf.edu/humanresources/employee-relations/workers-comp.asp RCDC 002.12 Rev. 04/2014 Registration Document for the Use of Infectious Agents and Biological Toxins USF Institutional Biosafety Committee Page i USF Employees, Residents, and Student Assistants classified as “Volunteers”: You must report all potential BBP exposures to your supervisor and then call AmeriSys. USF Students not on official “Volunteer” status and not employed by the University: Your care must be paid for through your student/personal insurance or by some other means If you are the supervisor: When an employee reports a work-related injury or illness, take prompt action to 1. Ensure the employee receives necessary medical attention. In case of emergency, call 911 or immediately send the employee to a hospital emergency room. Call AmeriSys as soon as practicable at 1-877-518-2583 to report the work-related injury or illness. 2. With the injured or ill employee, immediately call AmeriSys at 1-800-455-2079 to report the work-related injury or illness so the employee can receive appropriate care. Except in cases of emergency, the injured or ill employee must be present with the supervisor when the injury or illness is reported. 3. Complete the Accident Investigation Report for Supervisors and forward to Human Resources within 24 hours. 4. Take action to correct any safety hazards to prevent the same or similar injury or illness from occurring again. For questions on how to report a work-related injury or illness or other workers’ compensation issues, contact Workers’ Compensation Insurance Specialist Meica Elridge at (813) 974-5775 or melridge@admin.usf.edu. Reports may be faxed to (813) 974-7535. 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