ࡱ> be_`a /bjbjxx jj&  8 !t =$%(%%%++4+]=_=_=_=_=_=_=X@CL_= ,*@+,,_= %%t=111,j % %]=1,]=11V8@K9%p;՝k~m,8 I==0=8TZC7-&ZCK9K9&ZC q9,,1,,,,,_=_=]/D,,,=,,,,ZC,,,,,,,,, M: Institutional Biosafety Committee Recombinant and Synthetic DNA Research Registration For IBC Use OnlyIBC Registration Number:Date of Approval:Comment:  To meet federal guidelines the Principal Investigator working with recombinant or synthetic DNA must submit this registration document to ѿTV's Institutional Biosafety Committee (IBC). Registration instructions on the IBC page found under  HYPERLINK "http://www.uwyo.edu/safety/biological/IBC.html" Biological Safety web page. Return the completed document to Biological Safety  HYPERLINK "mailto:biosafety@uwyo.edu" biosafety@uwyo.edu. For more information call 766-2723. Section 1a: Project Information New ProjectRenewed 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 yearsUW Laboratory Safety Series Completion Date: (including Chemical Hygiene and Waste Generator Training. Must be within the last three (3) yearsOther Applicable Training, Date Completed:Biohazards:rDNA:Biohazards:rDNA:Biohazards:rDNA:Biohazards:rDNA: Section 2: Project Overview: Describe the project briefly in lay language Is this a Teaching Protocol?: YesNoIf yes, course number: Section 3: DNA information: a. Describe the source(s) of DNA:b. Describe the nature of the inserted DNA sequence:c. What hosts and vectors to be used?: d. Is a helper virus used?e. What animal or plant cells will be exposed to the recombinant? f. What cells or cell line will be used?g. Will a deliberate attempt be made to obtain expression of a foreign gene. If so, what protein, materials or antigens will be produced?h. Describe the hazards of the nucleic acids and agents involved:i. Are select agents involved? j. Do the nucleic acids or agent produces a lethal toxin? YesNo If so, describe:k. Will gene-drive modified organisms (GDMOs) be developed, or will transgenes or the combination of transgenes results in the preferential inheritance of recombinant DNA?  If so, describe: l. Will gene editing technologies be used (e.g. CRISPR/Cas9)? If so, describe: m. Will genetically engineered organisms be environmentally released or field tested?  If so, describe: n. Please specify the exact category of the experiments involving recombinant or synthetic nucleic acid molecules as per the NIH Guidelines (Section III). *Exempt experiments still need to be submitted to the IBC. For assistance, use the NIH Guidelines- Section III EXPERIMENTS COVERED BY THE NIH GUIDELINES (HYPERLINK "https://osp.od.nih.gov/wp-content/uploads/NIH_Guidelines.pdf"https://osp.od.nih.gov/wp-content/uploads/NIH_Guidelines.pdf)III-A-1-aIII-B-1III-B-2III-C-1III-D-1-aIII-D-1-bIII-D-1-cIII-D-1-dIII-D-2-aIII-D-2-bIII-D-3-aIII-D-3-bIII-D-3-cIII-D-3-dIII-D-3-eIII-D-4-aIII-D-4-bIII-D-4-cIII-D-5-aIII-D-5-bIII-D-5-cIII-D-5-dIII-D-5-eIII-D-6III-D-7-aIII-D-7-bIII-D-7-cIII-D-7-dIII-D-8III-E-1III-E-2-aIII-E-2-b-(1)III-E-2-b-(2)III-E-2-b-(3)III-E-2-b-(4)III-E-2-b-(5)III-E-3III-E-3-aIII-F-1 *III-F-2*III-F-3*III-F-4*III-F-5*III-F-6*III-F-7*III-F-8* 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: Note: Transgenic animals include vertebrates and invertebrates such as Drosophila, mosquitoes, fish, Caenorhabditis elegans, frogs, mice, and rats. Do the proposed experiments include the infection of animals? Yes, IACUC #: NoAre you using, creating, or breeding any transgenic animals?List species of transgenic animal and their strains for each species:Will transgenic animals generated or used have the potential to produce or release toxic or infectious products?a. Describe the procedures and study locations: b. How are animals and animal wastes treated and disposed?  Section 10: Plant Information: Do the proposed experiments use transgenic plants? If yes, describe (provide genus, species)Do the proposed experiments use invasive species or noxious weeds. Describe: Can transgenic plant(s) survive in the immediate geographic area? Describe:Can transgenic plant(s) interbreed with regional native species or noxious weeds? DescribeWill any of your work involve plant pathogens? Describe:a. 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 nucleic acid 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 and necessary precautions, 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.     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