PI Name:
Office of Research and Sponsored Programs: (361) 593-3344 or osr@tamuk.edu
B
T
U
F
1. Description of Biological Toxin (s)
1.1
Indicate what toxins (unfractionated mixture, purified conjugate, microbial culture capable
of producing toxin) will be used in these activities.
1.2
Describe the form of the toxin (e.g., liquid, particles):
1.3 Indicate the amount of toxin to be obtained:
1.4 Is there an antidote available for persons exposed to the toxin?
No
Yes
If yes, explain:
1.5
Provide the LD
50
if available of the purified toxin or crude venom, including species and route:
2. Location of Toxin (s) Production, Storage and Activities
2.1
Indicate where the toxin will be produced and/or stored.
Location (room and building):
2.2 Indicate where the toxin activities will be performed.
Location (room and building):
2.3 Will the toxin be weighed?
No
Yes
If yes, indicate location (room and building):
Revised: 10/29/13
1

PI Name:
3. Handling of Toxin(s)
Toxins must be handled in a chemical fume hood or biological safety cabinet. If a biological safety cabinet is used, indicate the most recent date of certification:
4. Animal Biosafety Level
If live animals are used, indicate the biosafety level in which they will be housed.
No animals
ABSL1
ABSL2
Location of animal housing (room and building):
5. Standard Operating Procedures
The following questions request information about Standard Operating Procedures that will be used for this project.
5.1 Experimental activities
Provide a summary of the laboratory activities that will be conducted.
5.2 Standard Operating Procedures
Attach detailed Standard Operating Procedures for the experimental activities described above.
5.3 Potential Hazards and Safety Procedures
Identify potential exposure hazards during sample preparation and experimental manipulations. Examples: aerosol generation when transferring, mixing and/or centrifuging, use of sharps, excretion by animals, culturing, etc.
Describe the safety procedures and safety equipment used to minimize risk and prevent release of infectious agents for each potential exposure hazard, e.g. lab coats, gloves, face shield, biological safety cabinet, secondary containment for liquids, spill mats, secondary containment for centrifuge samples, etc.
Potential Hazards
5.4 Waste disposal
Safety Procedures
Revised: 10/29/13
2

PI Name:
Attach the Waste Disposal Plan (available on OSR website: http://www.tamuk.edu/osr/forms.html
). Call the Environmental Health and Safety Office for information about waste disposal: (361) 593-2646 or (361) 593-4131.
5.5 Decontamination and Spill Clean-up
Attach the Decontamination Plan (available on OSR website: http://www.tamuk.edu/osr/forms.html
), including the sections entitled “Lab Specific
Requirements”. The plan must be customized for your laboratory.
You have reached the end of this form. Please make sure that you have responded to every question on this application (even if your response is “not applicable”) .
Save an electronic copy of this completed form and submit to osr@tamuk.edu. You will receive an electronic message from the Research Compliance Liaison within 2-3 days acknowledging receipt of your submission.
Submit to:
Research Compliance Liaison
Email as PDF to: OSR@tamuk.edu
Mail Code: MSC 201
Fax: 361-593-3409
Revised: 10/29/13
3