-1-
Formblatt Z
DOCUMENTATION OF GENTECHNOLOGY PROCEDURES FOR
SCIENTIFIC PURPOSES
For further procedures under safety level S1 (not covered by the initial application) please fill in 1-10 and 14.
For registered procedures (covered by the initial application or further procedures under safety level S2-4) or
approved procedures fill in 4, 7, 11, 12, 13 and 14.
1.
a) name and address of the operator:
Johann Wolfgang Goethe Universität
Stiftung des öffentlichen Rechts
Senckenberganlage 31
Postfach 11 19 32
60054 Frankfurt am Main
b) location of the gene technology facility:
2.
name of the project manager (Projektleiter):
3.
name of commissioner for biological safety (BBS):
4.
date and file reference
for the facility
for gene technology
procedures
Registration/safety inspection
according to the „Genrichtlinie"
Registration/approval according
to
GenTG
5.
title of gene technology procedures:
6.
safety level:
1

2

3
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
4

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Formblatt Z
7.
starting date of genetechnology procedures and period including long-term
storage:
from:
8.
to:
a) donor organsim:
b) nucleic acid species and purity:
c) vector(s):
d) receiving organism:
e) properties of the receiving organism (if relevant for safety assessment of
gene technology procedures):
f)
9.
properties of the genetically modified organsim relevant for safety level
classification:
description of the gene technology procedures including scientific purpose:
10. risk assessment of gene technology procedures:
11. change of safety level, reason, date (if applicable):
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Formblatt Z
12. Safety level 2: Further staff members directly involved in gene technology
procedures and their duties:
13. Further information for safety level 3 and 4 (§ 2 Abs. 4 GenTAufzV):
14. unexpected incidents with possible hazard for the subject of protection (§ 1
GenTG)
signature of operator or project director or person appointed by the latter:
place and date
name, title, official capacity
signature
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