Institution Biosafety Committee (IBC) STORAGE OF A NOTIFIABLE LOW RISK DEALING (NLRD)-APPLICATION 1 Project Title The title should be concise and convey the purpose of the dealing. 2 IBC Project Identifier (IBC office use only) 3a Project Supervisor Details Surname First Name Job Title School/Section Phone No. Email 3b Practitioners or Alternate Contact Surname First Name Job Title School/Section Phone No. Email 4a Title Title Description of the Dealing and GMO(s) Briefly describe the proposed dealing(s) and the purpose of conducting these dealing(s). Please use plain English. Please attach any references. University of Tasmania/NLRD Application Form/Version 1/Sep 2009 1 This table is intended to generate a concise, accurate record of all the GMOs to be generated or used and the purpose of the proposed dealings. Refer to Attachment 1 for information relating to the column headed “NLRD type”. Note: “Parent Organism” means organism(s) (or tissue derived from organism) that you propose to genetically modify. “Host” equates to “Parent”. 54b Common name Scientific name Vector(s) & What are What are the of parent of parent organism(s) organism(s) From what organism were method of the identities or classes the gene(s) responsible transfer modified of the gene (s) for the modified trait(s) traits (s) ? responsible for the isolated modified trait YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO University of Tasmania/NLRD Application Form/Version 1/Sep 2009 2 5 Containment facilities Provide information for all the facilities to be used in conjunction with this dealing. This information can be found on the orange sticker displayed on the door of the certified facility. FACILITY NAME BUILDING NAME TYPE e.g. PC2 lab University of Tasmania/NLRD Application Form/Version 1/Sep 2009 OGTR I.D. EXPIRY DATE 3 6 Risk Assessment and Risk Management Plan What are the risks to the health and safety of people from the proposed dealing(s)? Address possible risks to the health and safety of people, even if they are considered to be minimal. Include information about how these risks will be managed. What are the risks to the environment from the proposed dealing(s)? Address possible risks to the environment, even if they are considered to be minimal. Include information about how these risks will be managed. What do you intend to do in the event of the unintentional release of the GMO(s) into the environment? Include information about steps that will be taken to prevent the unintentional release of the GMO(s) into the environment. Does the dealing involve the importation of GMOs into Australia? Is a permit to import into Tasmania required? No Yes - Attach copy of permit (s) Will GMOs stored outside certified facilities be stored in locked storage units in restricted access areas? Yes No – Attach Details Do personnel involved in the dealing have appropriate training and experience? Yes No Is the parent organism a weed or closely related to plants that are weeds? Please identify any closely related weeds. Yes No To what stage of development will the plants be grown at the time of storage? (e.g. seeds) University of Tasmania/NLRD Application Form/Version 1/Sep 2009 4 OGTR expects laboratories to keep records of the storage place of all dealings under NLRD (s) permits such that the investigator or other practitioners can take auditors directly to any given GMO. Please indicate how this will be done for this NLRD (s) in your laboratory. Please provide the titles and reference numbers of the Standard Operating Procedures (SOPs) for transport and disposal of the GMO(s). You may be asked to produce these documents during the annual inspection of certified facilities. Have all the personnel (staff and students) involved in this project received training against the SOPs related to this dealing? Yes No You will be asked to produce training records during the annual inspection of certified facilities. 7 Declaration To be signed by the Applicant I DECLARE THAT: I am the applicant and principal research person; The dealings listed in this notification are Notifiable Low Risk Dealings (NLRDs); No additional work or extension of this dealing (bracket creep to another classification of a GMO dealing) will be undertaken without the permission of the IBC; Personnel involved in the dealings have appropriate training and experience. Name of Institute/School/Section (Please sign and initial every page) Printed Name Signature Job Title Date 8 Declaration To be signed by the Head of Institute/School/Section I DECLARE THAT: I am duly authorised to sign this declaration; The dealings listed in this notification are Notifiable Low Risk Dealings (NLRDs); No additional work or extension of this dealing (bracket creep to another classification of a GMO dealing) will be undertaken without the permission of the IBC; Personnel involved in the dealings have appropriate training and experience. Name of Institute/School/Section (Please sign and initial every page) Printed Name Signature Job Title Date University of Tasmania/NLRD Application Form/Version 1/Sep 2009 5 9 Declaration To be signed by the Chair, Institutional Biosafety Committee (IBC) I DECLARE THAT: I am duly authorised to sign this declaration; The dealings listed in this notification are Notifiable Low Risk Dealings (NLRDs). Chair, University of Tasmania Institutional Biosafety Committee (IBC) Printed Name Signature Job Title Date University of Tasmania/NLRD Application Form/Version 1/Sep 2009 6 Table 2 - Examples of responses to Part 4: The description of the GMO(s) The “parent organism” means the organism(s) (or tissue derived from organisms) that you propose to genetically modify and “host” equates to “parent”. If the host/vector system is not exempt please provide details of the system. 4.A 4.5 4.C 4.D 4.E and 4.F 4.G Common name of parent organism Scientific name of parent organism Vector(s) or method of transfer Exempt Host/vector system? (if no please provide details Modified trait Identity or class of gene(s) and organism of origin NLRD kind Mouse Mus musculus no (whole animals are not exempt unless listed under Schedule 2 Part 1) IGFII protein expressio n IGFII from Macropus eugenii (Tammar Wallaby) a) Thale cress Arabidopsis thaliana DNA Microinjecte d into mouse embryos Non tumorigenic disarmed Ti plasmid via vacuum infiltration no (although original transformation is of plant cell culture, the plantlets will be grown to maturity. Whole GM plants are not an exempt host) GFP gene from Aequorea victoria b) Bacteria Escherichia coli B strains Conjugative plasmids no (plasmids are capable of conjugation) bla gene (betalactamase, present on the plasmids) c) Tissue culture cells CHO and COS cell lines Vaccinia virus no (vaccinia virus is not a defective viral vector) E. coli K12 Nonconjugative plasmids yes (Note: Dealings may only be type E if the host/vector system is listed in Part 2 of Schedule 2 of the Regulations) Fibronectin genes from various mammalian species, GFP from A. victoria Unknown. Genes have a putative roles in oncogenesis and cell cycle regulation d) Bacteria Fluoresce nce expressio n of green fluoresce nt protein (GFP). Expressio n Ampicillin resistance gene Expressio n of fibronecti n genes and GFP As-yet unidentifie d genes will be overexpre ssed. Attachment 1 – Types of NLRDs University of Tasmania/NLRD Application Form/Version 1/Sep 2009 7 e) What is or are the kind(s) of notifiable low risk dealing? Below are the kind of NLRD dealings that are listed in the Regulations. Please tick the box(s) next to the statement that best describes the GMO(s) or methods that were used to produce the GMOs. (ie. if you were notifying the OGTR of a dealing to produce these GMOs, what type of NLRD would the dealing be classified as?) a. Any dealing involving whole animals (including non-vertebrates) that: (i) involves genetic modification of the genome of the oocyte or zygote or early embryo by any means to produce a novel whole organism; and (ii) does not involve gene-knockout mice b. Any dealing involving the production of a genetically modified flowering plant if: (i) the dealing does not involve the plant being grown to flowering stage; or (ii) for a dealing that does involve the plant being grown to flowering stage: (A) the plant is male sterile and is unable to set seed; or (B) if the plant is male sterile and can set seed —all vents and drains in the facility are screened with mesh or filters that block the escape of viable pollen and seed; or (C) before flowering, all inflorescences are wholly enclosed in bags designed to prevent escape of viable pollen and seed; or (D) if the plant can be wind-pollinated —all vents and drains in the facility are screened with mesh or filters that block the escape of viable pollen and seed; or (E) if the plant can be vector-pollinated only —all vents and drains in the facility are screened with mesh or filters that block the escape of viable seed and exclude pollen vector from the facility; c. Any dealing involving a host and vector that are not mentioned as a host/vector system in Part 2 of Schedule 2, if: (i) the host is incapable of causing disease in human beings, animals, plants or fungi; and (ii) the vector is incapable of causing disease in human beings, animals, plants or fungi d. Any dealing involving a host and vector that are not mentioned as a host/vector system in Part 2 of Schedule 2, if, although the host and vector are capable of causing disease in human beings, animals, plants or fungi, the donor DNA is fully characterised and will not increase the virulence of the host or vector. e. Any dealing involving a host/vector system mentioned in Part 2 of Schedule 2, if the gene inserted: (i) is a pathogenic determinant; or (ii) is uncharacterised DNA from a micro-organism that is capable of causing disease in human beings, animals, plants or fungi; or (iii) is an oncogene. General Information Notification of a notifiable low risk dealing (NLRD) This notification is for a new NLRD under the Commonwealth Gene Technology Act 2000 (the Act) and corresponding State law. Regulation 13 of the Gene Technology Regulations 2001 (as amended with effect from I July 2007 by the Gene Technology Amendment Regulations 2006) requires that an Institutional Biosafety Committee (i) confirms that an NLRD is a dealing of a kind mentioned in Part 1 of Schedule 3 of the Regulations; and (ii) considers that the personnel to be involved in the proposed dealing have appropriate training and experience. According to the Act, to “deal with” in relation to a GMO, means any of the following: (a) conduct experiments with the GMO; (b) make, develop, produce or manufacture the GMO; (c) breed the GMO; (d) propagate the GMO; (e) use the GMO in the course of manufacture of a thing that is not a GMO; (f) grow, raise or culture the GMO; (g) import the GMO; and includes the possession, supply, use transport or disposal of the GMO for the purposes of, or in the course of, a dealing mentioned in any of (a) to (g). Accuracy of information Please answer all questions unless otherwise indicated. Please check that the information provided in this notification is true and accurate. The Act provides for penalties to a person who knowingly gives information to the Regulator that is false or misleading. Confidentiality University of Tasmania/NLRD Application Form/Version 1/Sep 2009 8 If you wish to make an application for a declaration that specifies information is Confidential Commercial Information (CCI) for the purposes of the Act, you must also complete the CCI application form available at www.ogtr.gov.au and submit it at the same time as this notification. Privacy Any personal information is safeguarded by the Privacy Act 1988. This prevents the submitted personal information from being used for purposes other than assessing the certification application, or other circumstances specified by the Gene Technology Act 2000 (Commonwealth). In certain circumstances information supplied as part of a notification may, according to their specific needs, be given to the following: an officer or employee of the Department of Health and Ageing; an officer or employee of a State government agency or organisation; Courts, Tribunals and/or other Commonwealth agencies where it is an obligation under law to provide it; law enforcement authorities; and the relevant Minister. Authorisation Please ensure that if you are completing this notification on behalf of the organisation, you hold the proper authority to submit this application on behalf of the organisation. University of Tasmania/NLRD Application Form/Version 1/Sep 2009 9