Download Course Facility SOP Form - UC Davis Safety Services

UC Davis Biosafety Authorization for
Laboratory Course and
Facility Standard Operating Procedures
This submission involves:
Application type:
Date received:
ABSO Reviewer:
BSL/RG:
NIH Guidelines:
Recombinant DNA
New SOP #
Renew SOP #
Terminate SOP #
Major change
amendment, SOP #
Storage only, SOP #
Exempt under NIH Guidelines section: IIIF:
Infectious Agents
(Human, animal, or plant)
Bloodborne pathogens,
human & nonhuman primate
materials
Course Title or Facility Name:
Course Instructor or
Facility Manager:
Department:
Phone:
Fax:
Faculty Director/Supervisor:
Department:
Phone:
Fax:
IBC review dates
Action:
First review:
Second review:
Action:
Third review:
Action:
Third review:
Approval
date:
Action:
Storage only
App. C:
Title:
Building:
E-mail address:
Room:
Title:
Building:
Room:
E-mail address:
Check here if you have listed additional shared space owners or co-investigators on a separate sheet
Course/Facility Administrator:
Department:
Phone:
Fax:
Title:
Building:
E-mail address:
Room:
General conditions for approval
The course instructor or facility manger agrees to the following (please check boxes on the left):
Ensure that course attendees and facility users listed have received or will receive appropriate documented training in safe laboratory practices
and procedures for this protocol before work commences and at least annually thereafter
Follow the health surveillance practices as approved for this laboratory course or facility and inform those working on the protocol about
appropriate emergency assistance information for their location(s).
Inform EH&S (530 752 1493) and the occupational medicine physician (530 752 6051) of any accident or potential laboratory-acquired illness as
soon as possible after its occurrence.
Comply with UC Davis biosafety procedures, with UC Davis and UC systemwide biosafety policy and procedure, with the NIH Guidelines for
Research Involving Recombinant DNA Molecules, and with all other applicable laws and regulations.
Submit in writing (by SOP Amendment) a request for pre-approval from the Institutional Biosafety Committee (530 752 1493) for any significant
deviations from the biohazard containment or personnel protection provisions of the approved SOP, or any modifications to the study or additions
or deletions of personnel, facilities, recombinant or infectious agents, or procedures.
By signing below, I certify that I have reviewed the above conditions and agree that all laboratory course or facility personnel will abide by those
requirements and adhere to all UC Davis policies and procedures governing the use of recombinant DNA and infectious agents.
Course instructor or facility manager signature:
Date:
Faculty Director/Supervisor:
Date:
Department chair (required):
Date:
IBC chair:
Biological Safety Officer (Final Approval for previous Conditional Approvals ):
Date:
1
Date:
Project Abstract:
Please supply a brief description of your course or facility operations that specifies the agents or recombinant constructs to be used, the animal or plant
species (if applicable) to be used, and the types of potentially hazardous manipulations involved (e.g., aerosol generating, use of sharps, medical
waste generation). If doing recombinant DNA work, briefly discuss the involvement and function (if known) of the genes of interest in the project
objectives (including markers such as GFP, which are covered under the NIH Guidelines). Specify if your work involves gene discovery. Justify in
detail any large-scale work (>10L culture). Specify any issued or pending agency permits (e.g., USDA) that cover your work. Provide a brief overview
of the tests, processes, and components as applicable and their uses (e.g. for sequencing facilities specify the technology and analyzers in use, for
diagnostic laboratories specify the types of embedding and sectioning to be conducted, for courses involving genetic transformation specify the gene(s)
of interest, the vectors, the hosts, and the transformation methods). Please attach any SOPs that are established for the course or facility.
Biological safety cabinet information (use additional sheets if necessary)
I do not plan to use a biological safety cabinet in this project
Cabinet 1
Cabinet 2
Date of most recent certification
Brand
Class
Type
Model
Width
ft
Serial number
UC No.
Exhaust type (recirculating, canopy, or hard ducted)
Date of most recent certification
Brand
Class
Model
Width
ft
Serial number
UC No.
Type
Exhaust type (recirculating, canopy, or hard ducted)
Location (building and room)
Shared use?
With PI:
Location (building and room)
Shared use?
With PI:
Check here if you have listed additional biological safety cabinets on a separate sheet.
Work and equipment locations (use additional sheets if necessary)
Specific use
Lab biosafety level
Facility/Teaching laboratory location
BSL
Facility/Teaching laboratory location
BSL
Laboratory
or insectary location
BSL
Laboratory
or greenhouse location
BSL
Laboratory
or field planting location
BSL
Housed animals
ABSL
Autoclave for non-medical waste
Medical waste accumulation site or approved autoclave
Locked?
Storage:
RT
4º
-20º
-80 º
LN2
Locked?
Storage:
RT
4º
-20º
-80 º
LN2
Building
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
1
2
3
Yes
Yes
Room No.
Shared
space
No
No
Check here if you have listed additional locations on a separate sheet
List of attachments to this application
Laboratory Course or Core Facility Standard Operating Procedures (SOPs)
Course syllabus or course description
Animal Care and Use protocol Room/lab Safety Sheet and Personnel Roster (MANDATORY if vertebrate animals are used)
Agency permits (e.g. USDA/APHIS, CDFA)
Letter from off-campus facility director authorizing permanent transfer of biohazardous materials to the off-campus site
Bloodborne Pathogen Exposure Control Plan (Cal OSHA Title 8, Section 5193)
Medical Waste Management Plan (required for human pathogens, human, and non-human primate source material)
Aerosol Transmissible Disease Biosafety Plan (Cal OSHA Title 8, Section 5199)
Other documents:
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This page is not subject to F.O.I.A.* requests
Authorized users (use additional sheets if necessary)
Note: Complete this page for all employees involved with the laboratory course or core facility who have a potential for exposure to the biohazardous
materials. If the project includes vertebrate animal use, attach the list of authorized personnel from your Animal Care and Use protocol to this
application. The Biosafety Office and the IBC will keep the information on this page and on the animal care protocol page confidential.
Documented training
Name
UCD ID
Telephone
e-mail address
(text will wrap)
Biosafety1
BSC2
BBP3
and
MW4
Date hepatitis B
vaccine was
offered for BBP
ECP
DGR5
Plant
Biosafety6
Greenhouse Safety
Operations
Principal Investigator
Laboratory contact
Check here if additional users are listed on a separate sheet
1Biosafety=Formal
EH&S-provided or approved training in the principles and practices of biological safety, mandatory before beginning work; approved annual refresher training
required.
2BSC=Biological Safety Cabinet training (mandatory for users of Biological Safety Cabinets)
3BBP=Bloodborne pathogen exposure control training (if applicable, mandatory before beginning work, must be repeated annually)
4MW=Medical Waste management training (if applicable, mandatory before beginning work, must be repeated annually)
5DGR=Dangerous Goods Regulations (Federal law [Title 49 of the Code of Federal Regulations, Subtitle III, Chapter 51] requires personnel training on the transportation of
hazardous materials)
6Plant Biosafety=Training in the principles and practices of plant biological safety, mandatory before beginning work; annual refresher training required
Please note that the BBP and MW are given initially with the Biosafety class offered by EH&S. Annual refreshers should provide training for the BBP and MW in tandem.
*F.O.I.A.=Freedom of Information Act
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