Biohazard Risk Assessment Worksheet
Directions: 1. Read the information provided in the risk assessment
2. Complete all information highlighted in yellow.
3. The PI must sign in the designated areas, confirming that the procedures provided
are understood, and will be followed.
4. Submit the completed form to ibc@vt.edu
Agent Identification
Name: (genus/species or PrP isoform)
o Human and non-human primate blood, cell lines, tissues and bodily fluids
Type of Agent: (circle all that apply)
X Bacterium (potential)
Prion
Fungus
Rickettsia
X Parasite (potential)
Toxin derived from living organism
X Virus (potential)
Disease(s) caused by agent: Unknown – potentially various viruses, Hepatitis B, C, HIV, EPV and tumor
production. Potentially bacterial and parasitic diseases.
Health Hazards
Pathogenicity:
X Potential pathogen

Pathogenic

Highly pathogenic

Opportunistic pathogen
X Other: potentially tumorogenic
Epidemiology:
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Host Range: (check all that apply)
X
humans
X
animals (specify) potentially
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Risk Assessment Worksheet
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plants (specify) ________________________________________________________________
Infectious Dose:

X
known ____________________
unknown
Mode of Transmission: (check all that apply)
Direct Contact
X human/human – through bodily fluids

human/animal
Indirect Contact

vector-borne

inanimate objects

food, water, air
Route of Entry: (check all that apply)
X ingestion

inhalation
X penetration through skin
X contact with mucous membranes of eyes, nose, and mouth
Incubation Period: Unknown/variable
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Communicability:
X person-to-person transfer – by bodily fluids

no evidence of person to person transfer

suspected person-to-person transfer
Dissemination
Reservoir: Specimens, samples or cultures in lab
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Zoonosis: Unknown

No
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
Yes
(name):________________________________________________________________________
Vectors: Unknown

None

Yes (name):____________________________________________________________________
Viability
Drug Susceptibility:
Variable based on pathogen and disease. Will be determined by physicians orders
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Disinfectant Susceptibility:
70% ethanol, .1% sodium hypochlorite (1:50 dilution household
bleach)
Add other specific disinfectants for your lab:
Physical Inactivation: autoclaving at 121C for 15- 30 minutes
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Survival outside Host: Unknown
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Medical
Surveillance: Self monitor for redness and swelling in affected area.
First Aid/Treatment: accidental self inoculation - Immediately wash affected area with soap and water.
Make the site bleed a little to help flush out any material. Inform supervisor and get medical attention if
needed. Consult with occupational or other physician.
Immunization:
Hepatitis B vaccine
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Prophylaxis:
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Risk Assessment Worksheet
Laboratory Hazards
Laboratory-Acquired Infections (epidemiology of lab-acquired infections):
Those caused by bloodborne pathogens (HIV, HBV, HCV, EBV), bacteria or parasites
Potential for tumor production
Sources/Specimens:
Specify source of material
Primary Hazards:
Self inoculation or spill on an open wound, cut of scratch.
Splash to eyes or mucous membrane
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Special
List any specific hazards involved with your work:__________________________________________
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Recommended Precautions
Containment Requirements: I confirm that all work with human cell lines will occur at Biosaftey Level 2:
PI electronic signature:
Personal Protective Equipment: Lab coat and gloves. Any open wound, cut or scratch will be covered
with a bandage. Eye protection will be worn if any procedures are done outside the biosafety cabinet
which may produce a splash. I confirm that this is the minimum PPE that will be used:
PI electronic signature:
Other Precautions: Work will be performed in a biosafety cabinet. Sharps use will be kept to the absolute
minimum. Plastic ware will be used whenever possible. Needles used to inoculate mice will be placed
directly into sharps container or the one handed recapping method used.
Add any other lab specific precautions:
I confirm that these precautions will be used:
PI electronic signature:
Handling Information
Spills:
Inform others in the area of the spill. Place paper towels on spill. Leave area if large spill.
Remove contaminated PPE. Don clean PPE (lab coat, gloves, eye protection/ splash protection). Pour
disinfectant ( 1% sodium hypochlorite – 1:5 dilution household bleach) on area. Wait 10 minutes. Clean
up and repeat as needed.
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Risk Assessment Worksheet
Disposal:
All solid waste will be collected in orange biohazard autoclave bags, autoclaved and disposed of
in regulated medical waste (RMW) as per EHS.
Sharps will be collected in sharps containers, autoclaved and placed into RMW.
Liquid waste will be diluted with household bleach (1:5). Allowed to sit for 10 minutes and
poured down the drain followed by water.
Storage: sealed tubes in freezer labeled with biohazard sticker
no special requirements
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Miscellaneous Information/References
Personnel working with human and non-human primate blood, blood products, tissues and body
fluids must complete Bloodborne pathogen training annually.
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Congratulations! You now have a material safety data sheet for your biological agent.
EHS Form (06-11)
Risk Assessment Worksheet