IBC-2
Rev.: 6/2013
FORM IBC-2: For research involving biohazardous materials
1. Please list the name(s) of pathological agents (e.g. bacterial or viral pathogens), biological
toxins, oncogenic material or potentially infectious human-derived material (e.g. blood,
tissues or cell lines – including commercially purchased) and check all that apply (if
additional listings are required, provide an addendum including the below information for
each additional item):
Name:
Strain, genotype, catalog # or CAS no:
Is it potentially pathogenic or toxic to:
Human
Animal
Plant
Unknown
Human
Animal
Plant
Unknown
Human
Animal
Plant
Unknown
Name:
Strain, genotype, catalog # or CAS no:
Is it potentially pathogenic or toxic to:
Name:
Strain, genotype, catalog # or CAS no:
Is it potentially pathogenic or toxic to:
2. Do you work with quantities greater than 10L at one time?
Yes
Largest volume
No
3. Do you inactivate the agent (i.e., add a fixative) prior to other laboratory manipulations?
Yes
No
4. Do you concentrate the agent or material?
Yes
No
Method(s):
Centrifuge
Filtration
Precipitation
Other Please Specify:
5. Are you using any primary cells, established cell lines, tissue, or blood?
Yes
No
If yes, are they: Human
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Other animal
IBC-2
Rev.: 6/2013
NOTE: If using non-human primate cells, please complete Form IBC-4.
6. Will you be inserting the agent or material listed in question 1 into animals or plants?
Yes
No
If yes, species and location of animal or plant housing:
AND: please complete FORM IBC-5 (animals) or IBC-6 (plants)
7. Biological containment level required for this protocol:
BL-1
BL-2
BL-2/3
BL-3
If BL-2/3 or BL-3, have you been trained? :
Yes
No
8. Please make an assessment of the risks to personnel working with the agents or materials
listed in question 1. This should include the risk for each agent and the route of exposure.
Also, explain whether combinations of these materials could present additional risks.
9. What prophylaxis will need to be taken regarding the assessment of the risks noted in
question 8 above? Please be specific for each agent listed in question 1. (Will
immunizations, etc. be needed?)
10. From among the items listed below, indicate the items to be utilized as part of the safety
practices associated with this work. Please check all that apply.
Methods of inactivation or disposal of the agent or contaminated materials:
Liquid waste final concentration 10% bleach
Solid waste red bag box system
Autoclave waste then deposited into red bag box system
Other (Please specify)
Class and type of Biological safety cabinet:
Class I
Class II type A1
Class II, type A2
Class II, type B1
Class II, type B2
Class III (glovebox)
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IBC-2
Rev.: 6/2013
In addition to a lab coat, other Personal Protective Equipment that will be used:
Gloves:
vinyl
latex
nitrile
other (please specify)
Wrap around gown
Mask
Goggles
Respirator (N-95 HEPA)
Head cap
Foot covers
Other (Please specify)
11. Please attach a description of the Safety Standard Operating Procedures governing this
work in your laboratory. If necessary, specifically describe the additional safe practices,
equipment, and facilities that will be used to protect personnel from exposure to the agent or
material listed in question 1; in particular, are there any special procedures to follow?
12. Please describe the method and precautions that will be taken when transporting specimens
and materials from your lab to other locations within Jefferson. NOTE: If transporting
specimens off-site or shipping infectious materials outside of the university, please contact
the Biological Safety Officer (x3-7422) for specific IATA training.
13. Do you have IRB (Human Subjects) Approval for this protocol
Yes
Pending
N/A
IRB Control #
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