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Office use: Ref No. ……………………….. Date Received. ………………….. Notification of Intention to Handle Potentially Hazardous Biological Agents This form is to be completed by all staff and students undertaking research where potentially hazardous biological agents are involved. This will ensure that staff and students will comply with all the legislation that regulates the manipulation of biological agents and ensure the Institute Biosafety Committee (IBC) is kept informed of the nature and range of biological agents on campus and those risks associated with the proposed work have been identified and adequately controlled. This form should be completed in conjunction with careful reading of the Biological Safety Manual and Making the Workplace Safe Please answer the questions in each section by clicking in the check boxes () and provide all information where indicated. Then you and your supervisor should sign and date this form and submit all documents to the Chair of the IBC for consideration. Personal Details Name: Student/Staff No: Position: Division: Supervisor: Phone: Email: Section A Description of Biological Agent(s) (Please answer by clicking the check box ) Origin: Human Animal Plant Microorganism Blood Sputum Urine Tissue Other Please specify: Faeces Other Please specify: Infectious microorganisms: please only include infectious microorganisms Bacterium Virus Fungus/Yeast Parasite Other Please specify: Please list the infectious agents, specify their genus and species and risk category (consult Biological Safety Manual, Appendix A) Genus Species Risk Category Animals; please list all animals, probable numbers and indicate if any of the animals are likely to be infected and, if so, by which infectious agent Genus Species Numbers Infected? Infectious agent? No Yes Unsure No Yes Unsure No Yes Unsure No Yes Unsure Plants; please list all plants, probable numbers and indicate if any of the plants are likely to be infected and, if so, by which infectious agent Genus Species Numbers Infected? Infectious agent? No Yes Unsure No Yes Unsure No Yes Unsure No Yes Unsure Section B Description of Project Project Title / Unit of Study Brief Project Description Location(s): Commencement date: Completion Date: Section C Security Sensitive Biological Agents (SSBAs) SSBAs are biological agents that may be deliberately misused by terrorists to harm human health or the Australian economy. The acquisition, isolation, storage, handling, transport and disposal of SSBAs is governed by National Health Security Act 2007 (NHS Act) and implemented by the Federal Department of Health and Ageing (DoHA). Non-compliance may be prosecuted with an offence under the NHS Act. SSBAs are grouped into two tiers. Tier 1 Agent Abrin Bacillus anthracis Botulinum toxin Ebolavirus Foot-and-mouth disease virus Influenza virus Marburgvirus Ricin Rinderpest virus SARS coronavirus Variola virus (Smallpox) Yersinis pestis (Plague bacillus) Quantity 5 mg 0.5 mg Comments Virulent strains of anthrax Does not apply to forms of toxin approved for use under Therapeutic Goods Act 1989, eg BotoxTM Only highly pathogenic strains infecting humans 5 mg Tier 2 Agent African swine fever virus Capripoxvirus Classical swine fever virus Clostridium botulinum (Botulism) Francisella tularensis (Tularæmia) Lumpy skin disease virus Peste-des-petits-ruminants virus Salmonella typhi (Typhoid fever) Vibrio choleræ (Cholera) Yellow fever virus Comment Sheep pox virus and Goat pox virus Toxin-producing strains Serotypes O1 and O139 only Non-vaccine strains Question 1 Do you intend to acquire, isolate, store, handle, transport or dispose of any of the SSBAs listed in Tier1 or Tier 2? (Please answer by clicking the check box ) No Go to Question 2 Yes Carefully read the chapter “Security Sensitive Biological Agents” in the Biological Safety Manual Fill in the appropriate forms as recommended by the Biological Safety Manual and submit copies to the DoHA and Chair of the IBC You must not commence work involving the SSBAs until you (the entity) and your laboratory (the facility) have been registered with DoHA Question 2 In the course of your normal testing and experimental procedures is it possible that you may a) Handle biological specimens containing a presumptive SSBA? b) Isolate a presumptive SSBA? c) Conduct tests on samples taken from a source known to have a presumptive SSBA? No Go to Section D Yes When you become aware of the presence of a presumptive SSBA you have three options: Option 1: Immediately notify the Chair of the IBC and destroy all samples and cultures Option 2: Immediately notify the Chair of the IBC and transfer all samples and cultures to a reference laboratory registered to handle these SSBAs Option 3: Immediately notify the Chair of the IBC and report your holdings to the DoHA within 2 business days. Fill in the appropriate forms as recommended by the Biological Safety Manual and submit copies to the DoHA and Chair of the IBC Section D Importing biological material into Australia subject to Quarantine Regulations The Australian quarantine system is designed to prevent the importation and consequent introduction, establishment or spread of human, animal or plant pests and diseases. As a general rule any biological material imported into Australia and derived from water, soil, plant, insect or animal tissue will require an import permit issued by the Australian Quarantine and Inspection Service (AQIS). Question 3 Do you intend to import any biological material into Australia? (Please answer by clicking the check box ) No Go to Question 4 Yes Carefully read the chapter “Biological Material Subject to Quarantine Regulations” in the Biological Safety Manual Apply for an import permit from AQIS and nominate one of the Quarantine Approved Facilities at Curtin for storage and handling of the imported material Email a copy of the form to the Chair of the IBC and post the form along with payment to: Australian Quarantine and Inspection Service GPO Box 858 Canberra ACT 2601 Working with biological material subject to an AQIS permit All work with biological material imported with an AQIS permit is subject to AQIS regulations whether you were the primary importer or it was imported by someone else. Also AQIS approves facilities where work on a range of imported plants, animals and plant and animal products may be carried out so that it can be sure that these activities are performed with a minimal degree of risk. Question 4 Do you intend to work with biological material imported into Australia and required by AQIS to be stored and handled in Quarantine Approved Premises (QAP)? (Please answer by clicking the check box ) No Go to Question 5 Yes Carefully read the chapter “Biological Material Subject to Quarantine Regulations” in the Biological Safety Manual You must comply with AQIS regulations and maintain the level of containment approved by AQIS for the original importation. Question 5 Do you intend to transport quarantined biological material between QAPs? (Please answer by clicking the check box ) No Go to Section E Yes Carefully read the chapters “Biological Material Subject to Quarantine Regulations” and “Transport and Shipping of Infectious and Other Biological Materials” in the Biological Safety Manual You must obtain approval to transport biological material between QAPs by filling in the appropriate form, send a copy to the Chair of the IBC post the original to: Australian Quarantine and Inspection Service GPO Box 858 Canberra ACT 2601 Section E Handling Genetically Modified Organisms (GMOs) A GMO is a viable biological entity capable of reproduction or transferring genetic material that has had its genetic material modified by any technique apart from: sexual reproduction homologous recombination somatic cell nuclear transfer Note this definition of a GMO does not include hybridomas, plants formed by protoplast fusion and organisms resulting from naturally occurring DNA exchange. Question 6 Do you intend to use, culture, import, store and/or construct a GMO? (Please answer by clicking the check box ) No Go to Section F Yes Carefully read the chapter “Genetically Modified Organisms (GMOs)” in the Biological Safety Manual Go to Question 7 Question 7 What type of dealing(s) will you be conducting with a GMO? (Please answer by clicking the check box ) Exempt dealing Prior to or at the time of commencing work with the GMO you must fill in the appropriate form and send a copy to the Chair of the IBC for confirmation of the dealing. NLRD (Notifiable Low Risk Dealing) You must fill in the appropriate form and submit a copy to the Chair of the IBC. You must not commence work with the GMO until you have received written approval from the IBC. If you have not been trained to handle GMOs you must book yourself into one of the training workshops provided by Curtin Health and Safety. DNIR (Dealings Not Involving Intentional Release) An application for a DNIR licence must be completed, a copy sent to the Chair of the IBC and the original posted to: Office of the Gene Technology Regulator Commonwealth Department of Health and Ageing MDP 54, PO Box 100 Woden ACT 2606 A decision on your application will be made by the OGTR within 90 working days. Work with a DNIR must not commence until a licence has been issued by the OGTR. If you have not been trained to handle GMOs you must book yourself into one of the training workshops provided by Curtin Health and Safety. DIR (Dealings Involving Intentional Re lease) An application for a DIR licence must be completed, a copy sent to the Chair of the IBC and the original posted to: Office of the Gene Technology Regulator Commonwealth Department of Health and Ageing MDP 54, PO Box 100 Woden ACT 2606 Notification of the decision will be made within 150-255 working days depending on details of the dealing. Work with a DIR must not commence until a licence has been issued by the OGTR. A DIR licence will be issued subject to statutory conditions with which you must comply. Section F Risk Assessment If you are able to determine the level of risk associated with this biological agent(s) (see Appendix A in the Biological Safety Manual) and you will be conducting all work with appropriate safety protocols and within a laboratory designed to handle this level of risk then you do not need to carry out a biological risk assessment. Question 8 Will you be conducting all work with the biological agent(s) in a laboratory classified to handle the level of risk associated with the biological agent? (Please answer by clicking the check box ) No Complete the Risk Assessment Sheet below Yes You do not need to complete a biological risk assessment. If there are other physical and/or chemical risks associated with your project then you should complete a risk assessment sheet. Risk Assessment Sheet To complete this risk assessment please consult ‘Making the Workplace Safe’ for guidance and an explanation of terms. Hazards: Ranking: Controls: Identify potential sources of Rank potential risks with Use the hierarchy of controls to harm or ill-health to respect to the likelihood of a determine the best methods to staff/students or others. hazard causing an incident control the hazards identified. and the consequence of that Eliminations incident. Substitution E – Extreme risk Isolation H – High risk Engineering M – Medium risk Administration L – Low risk Personal Protective Equipment Continue on additional sheet if necessary Section G Acknowledgement and Signature of Applicant I, , hereby acknowledge that I have read and understood all legislation and regulations concerning the biological agents declared in this notification. I also undertake to comply with all regulations and conditions imposed by regulatory authorities and the IBC. Signature: Date: Acknowledgement and Signature of Supervisor I, , hereby acknowledge that I have read and understood all legislation and regulations concerning the biological agents declared in this notification. I also acknowledge that I have read and approved the project and its risk assessment. Signature: Date: Submission of Notification Forward a copy of your Notification to the Chair of the IBC in order to obtain necessary approvals. Submit applications, reports and registration forms to relevant authorities as required by Legislation and Regulations. Keep a copy of all your documents for your records