Office of Regulatory Compliance & Safety
2013
Mississippi State University
Institutional Biosafety Committee
Application Update/Modification/Completion Form
If you have changes in: personnel, laboratory location, experimental methods, biohazardous materials,
or facility containment level please submit this form. The form will be reviewed by the IBC Chair and BSO
to determine if the changes are significant enough to warrant a new IBC application. A modification
must be approved by the IBC prior to initiation of the modified protocol.
IBC Application Number:
Principal Investigator:
This form is being used for:
□ Annual update with no project changes (Complete page 1 only).
□ Modification to ongoing project
□ Annual update with modification
□ Completed Project (Complete page 1 only).
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I certify that the information provided in this form is complete and accurate and consistent with
any proposal(s) submitted to external funding agencies.
I agree that modifications to the originally approved project will not take place without prior review
and approval by the IBC, and that all activities will be performed in accordance with all applicable
federal, state, local and Mississippi State University policies.
I will follow applicable biosafety level requirements; comply with all shipping requirements and
waste management practices.
I will ensure that all personnel have appropriate training including but not limited to: biosafety
principles and techniques, accidental spill response, and proper handling of biohazardous
materials and waste management.
I am aware that the IBC reserves the right to conduct inspections of the research facilities at any
time.
Signature of Principal Investigator
Date
Approved by IBC Chair
Date
Approved by BSO
Date
Office of Regulatory Compliance & Safety
2013
PROPOSED CHANGES
Please answer yes or no for each question. Detail any changes from the previously approved
project. Please provide sufficient detail for each change to allow the IBC to make an adequate review.
1. Change In Location
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Delete
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Yes
2. Personnel Changes Yes
Add
Delete
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No
Building, Field Location, Greenhouse
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No
Delete
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4. Change in Biosafety Level Yes
Room Number
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Name
3. Organism/Toxin/Cell Culture Change
Add
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Position
Yes
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No
Training
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Organism/Toxin/Cell Culture
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No
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From ___________ to ____________
Office of Regulatory Compliance & Safety
5. Change in Use of Human Materials Yes
Add
Delete
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Yes □
Yes □
Yes □
Yes □
Yes □
Yes
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No
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Type of Material (blood, tissue, body fluids)
6. Change in rDNA Yes
Yes
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2013
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No □
No □
No □
No □
No □
No
□ If yes, describe changes in the last column.
Host(s)
No
No
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Host Range
Nature of DNA
Source of DNA
Vector(s)
Expression of a Foreign
Gene: if yes describe any
possible toxicity or hazards
Helper Virus/
Defective Virus
7. Change in Laboratory Procedures Yes
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No
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If yes, please summarize.
8. Change in Animal Procedures (species, procedures etc) Yes
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No
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If yes, please describe.
9. Comments: (this page can be used to provide additional information or explanation for the IBC to
consider the proposed changes to the project).