Download the Sort Application form

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SORT APPLICATION-MedH FLOW CYTOMETRY FACILITY
THIS SECTION WILL BE FILLED BY THE FACILITY
Sort ID:
Summary risk assessment for sorting:
Choice of security level for sorting (Biosafety level 1 (BSL1), Biosafety level (BSL2),
Biosafety level 2 with containment in microbiological safety cabinet class 1 or II (BSL2:MSC) or
Biosafety level 2 respirator (BSL2:Resp):
Investigator’s details
Name:
Group Leader:
Tel (Mob):
E-mail:
KI Ref: ZZ
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Sort details
Sorter:
Operator:
Date:
Estimated start time:
Estimated sample size and number of samples:
Sort modes (bulk, single-cell, other) and collection (tube, 96-plate, slide):
Viability dye (no/yes, specify)
Sort antibody panel:
Please write a brief description of the purpose of the sort including the populations to be
sorted, including the number of cells required by each sorting mode:
Please show calculations to justify both the number of target cells and the sample size:
e.g. Target population frequency = 0.1%’
Number of target cells required = 1000
Sample size = 3 x 106
Theoretical yield incl. 50% sort yield = 1500
Staining protocol including controls (negative, comp tubes, FMO etc…) attached
Has the staining panel been used before? If so, please include profiles:
Sample temp:
Collection temp:
Collection medium:
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Other special requests:
Risk assessment and choice of safety levels during cell sorting
If the material to be sorted is identical to previously risk assessed material, reference (sort
Id and date) can be given to that sort application, instead of filling it in again below.
Are cells fixed or alive?
Species of cell to be sorted
What is the origin of the cell (eg. from ATCC, sample from healthy donor…)
Primary cell, yes/no
Cell line
Risk assessment by ATCC or similar
If human primary cells, have donor/patient been tested and found negative for HBV, HCV
and HIV, or other for the patient or individual relevant pathogens?
If the sample contain known infectious agents, what infectious agents? Have the infectious
agents been inactivated? If yes, how?
Could there be any unknown infectious agents in the material to be sorted?
Has the cell been genetically altered (GMM)?
Method for genetic alteration
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Time point of the genetic alteration/ number of passages (was it done less than a week ago?)
What kind of vector was used? (retro/lenti or other)
Name of expression vector
Packaging method (generation of retroviral system, transient transfection or stable
producer line)
Envelope used (Ecotropic, amphotropic, VSVg or other)
Nature of insert
Is the insert associated with or suspected to be involved in cellular transformation or
associated with any other biological risk?
Who made the viral transduction (in the research group or by someone else)?
How has presence of free viral particles been eliminated (time after transduction, number
of washes, other method)?
Overall risk assessment for sorting:
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Date:
Sort Id:
Signature group leader:
Signature investigator:
Signature responsible for sort facility: