BIOSAFETY LABORATORY INFORMATION
Section 1 - Complete this section for ALL labs:
Date:
Building Name and #:
Room #:
Principle Investigator:
Phone Number:
Home Phone or Pager:
Secondary Contact:
Phone Number:
Home Phone or Pager:
Are microorganisms or blood/body fluids used in the lab?
Yes 
No 
If yes, complete Section 2. Also, complete Section 2 for labs listed on the Biosafety Lab Posting Report.
_____________________________________________________________________________
Section 2
List ALL microorganisms (viruses, bacteria, fungi) used/stored in the Laboratory:
(Please list specific names of organisms, i.e. E. Coli, S. Aureus)
Are Blood and/or Body Fluids Used in the Laboratory?
Yes 
No 
Are Human Cell Lines used in the Laboratory?
Yes 
No 
Are Animal Cell Lines used in the Laboratory?
Yes 
No 
Is recombinant DNA used in the Laboratory?
Yes 
No 
Do you plan to purify, concentrate or produce high volumes of any animal or human pathogens?
Yes 
No 
If so what pathogen?________________________________
What Biosafety Level is currently assigned to the laboratory?
(Ask the Principle Investigator for this information. If they ask you what this mean, tell them that labs are
assigned a Biosafety Level based on the level of hazard posed by the microorganisms used in their laboratory.
If they don’t know, the UNM Biosafety Officer will assign a hazard rating based on the organisms listed above.
D:\533559565.doc
3/15/02