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Committee
Biological Agent and Toxin Usage Registration
For IBC Use OnlyIBC Registration Number:Date of Approval:Comment:
Biological agents are organisms, viruses, or toxins derived from a biological source. Registration instructions on the IBC page found under HYPERLINK "http://www.uwyo.edu/safety/biological/IBC.html" Biological Safety web page. Complete this form and send to HYPERLINK "mailto:biosafety@uwyo.edu" biosafety@uwyo.edu. For more information, call 766-2723.
Section 1a: Project Information
New Project Renewed Project (expired IBC approved project wanting to renew for another 3 years)Update/ Annual Update Project, if checked please mark changes in red
Project Title:Section 1b: Basic Contact Information
Principal Investigator: Title: Department: Building:Office #:Phone:UW Email:
Co- Investigator: Title: Department: Building:Office #:Phone:UW Email:
Lab Contact: Title: Department: Building:Office #:Phone:UW Email:
Section 1c: Lab Personnel & Safety Trainings
All personnel authorized to handle organisms must complete CITI online training (Training for Investigators, Staff and Students Handling Biohazards. (ID: 62063), NIH Recombinant DNA (rDNA) Guidelines (ID: 62071), and other appropriate modules such as Animal Biosafety (ID: 62065) or Bloodborne Pathogens training) and UW Laboratory Safety Series before initiating the protocol. Find the link to CITI training at the bottom of the IBC page found in HYPERLINK "http://www.uwyo.edu/safety"http://www.uwyo.edu/safety.
For more information contact HYPERLINK "mailto:biosafety@uwyo.edu" biosafety@uwyo.edu.
List personnel authorized to handle organisms and dates of training:
NameRole on Project
(e.g. PI, undergraduate student, Graduate student, Postdoc Student)Most Recent CITI Training Completion Date:
(Must be within the last three (3) years)UW Laboratory Safety Series Completion Date: (including Chemical Hygiene and Waste Generator Training. Must be within the last three (3) years)Other Applicable Training, Date Completed:
Section 2: Project Overview: Describe the project briefly in lay language:
Is this a Teaching Protocol?: YesNoIf yes, course number:
Section 3: Biological agents or toxins information: a. Biological agent or toxin:b. Describe the hazards of the agent or toxin:c. Is the agent or toxin a select agent?d. Does the agent produce a lethal toxin?
If so describe:
Section 4: Risk Group of Agent(s): For more information see: HYPERLINK "https://my.absa.org/Riskgroups" https://my.absa.org/Riskgroups Risk Group 1:Risk Group 2:Risk Group 3:
Section 5: Biocontainment: Biosafety Level: For more information see: HYPERLINK "https://www.cdc.gov/labs/BMBL.html" https://www.cdc.gov/labs/BMBL.htmlBSL-1BSL-2BSL-3ABSL-1ABSL-2ABSL-3PL-1PL-2Biosafety cabinet location (building and room#): Certification date:
Section 6: Location information: Please list all locations by building and room numberLocation of experiments:Location of agent storage:Location of Pathogen Safety Data Sheet:Location of Inventory Log:Location of Laboratory Safety Manual:
Section 7: Potential Exposures: a. Identify pre-exposure vaccines or other medical treatment in advance of working with the agent:
b. Describe treatment in the event of an accidental exposure and whether it is locally available (public health, IMH, etc.) Please attach medical cards and PSDS to packet if applicable:
c. Describe or attach laboratory emergency procedures (i.e. spills of chemicals, needlesticks, infectious materials or medical emergency):
Section 8: Personal Protective Equipment (PPE) required: Laboratory CoatSafety GlassesNitrile Glove Surgical Face MaskShoe Covers (Booties)Face Shield ScrubsSteel-Toed BootsLeather or Kevlar GlovesOther:
Section 9: Animal Information: Do the proposed experiments include the infection of animals (including transgenic animals)? Yes, IACUC #:NoDo the proposed experiments include working with wild animals that are potentially infected?Yes, IACUC #:Noa. If yes, describe the procedures and study locations:
b. How are animals, animal wastes, or animal samplings treated and disposed?
Section 10: Plant information: Do the proposed experiments include the plant pathogens (including infecting plants or transgenic plants)? YesNoIf yes, Describe:Describe the procedures and study locations: (UW Greenhouses, Field, etc)
b. How are plants/plant material treated and disposed of?
Section 11: Laboratory Experiment Description: a. Does the experiment involve single containers of cultures greater than one liter?YesNoIf yes, how much:
b. Describe agent handling and experimental procedures:
Section 12: Describe decontamination and disposal procedures:
Note: Include Autoclave parameters, disinfects used, etc.
This information above is accurate and complete. I agree to abide by the following requirements.
Please initial each statement and electronically sign below:
Be adequately trained in good microbiological techniques.Provide laboratory research staff with protocols describing potential biohazards, necessary precautions, and emergency medical plan with medical cards, if treatment is necessary.Inform animal caretakers of the risks associated with the biological agent or toxin used in the research on the animals, if animals are involved in the research.Instruct and train lab staff in (i) the practices and techniques required to ensure safety, and (ii) the procedures for dealing with accidents. Inform the lab staff of the reasons and provisions for precautionary medical practices advised or requested (e.g., vaccinations or serum collection).Supervise lab staff to ensure that the required safety practices and techniques are employed.Correct work errors and conditions that may result in the release of recombinant or synthetic nucleic acid materials.Ensure the integrity of physical containment (e.g., biological safety cabinets) and biological containment (e.g., host-vector systems that preclude survival of the agent outside the lab).Comply with permit and shipping requirements for recombinant or synthetic nucleic acid molecules.Adhere to the IBC-approved emergency plan described above for this project for handling accidental spills and personnel contamination.Submit any subsequent changes (e.g., changes in the source of DNA or host-vector system) to the IBC for review and approval or disapproval. Remain in communication with the IBC throughout the duration of the project (e.g., submit an annual updates/ changes form for the project).Report any significant problems pertaining to the operation and implementation of the containment practices and procedures, violations of the NIH Guidelines, or any significant research-related accidents and illnesses to the IBC, NIH-OBA, Biological Safety Specialist, and as applicable the Animal or Greenhouse Facility Director, and other appropriate authorities.
Principal Investigator:Date:Signature
Send to HYPERLINK "mailto:biosafety@uwyo.edu" biosafety@uwyo.edu with the subject line New IBC Project Submission For more information, call 766-2723.
Biological Agent and Toxin Usage Registration Revision 12-2025
UW Safety Office
Institutional Biosafety Committee Page PAGE \* MERGEFORMAT 1
Revision 12-2025
UW Safety Office
Institutional Biosafety Committee Page PAGE \* MERGEFORMAT 1
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