Download Biohazard Risk Assessment Worksheet

Biohazard Risk Assessment Worksheet
Agent Identification
Name: (genus/species or PrP isoform)
Type of Agent: (circle all that apply)
Bacterium
Prion
Fungus
Rickettsia
Parasite
Toxin derived from living organism
Virus
Human Cells/blood/tissues
Disease(s) caused by agent:
Health Hazards
Pathogenicity:
Potential pathogen
Pathogenic
Highly pathogenic
Opportunistic pathogen
Other:
Epidemiology:
Host Range: (check all that apply)
humans
animals (specify)
plants (specify)
Infectious Dose:
known
unknown
Mode of Transmission: (check all that apply)
Direct Contact
human/human
human/animal
EHS Form (06-11)
Risk Assessment Worksheet
Indirect Contact
vector-borne
inanimate objects
food, water, air
Route of Entry: (check all that apply)
ingestion
inhalation
penetration through skin
contact with mucous membranes of eyes, nose, and mouth
Incubation Period:
Communicability:
person-to-person transfer
no evidence of person-to-person transfer
suspected person-to-person transfer
Dissemination
Reservoir:
Zoonosis:
No
Yes (name):_
Vectors:
None
Yes (name):_
Viability
Drug Susceptibility:
Disinfectant Susceptibility:
EHS Form (06-11)
Risk Assessment Worksheet
Physical Inactivation:
Survival outside Host:
Medical
Surveillance:
First Aid/Treatment:
Immunization:
Prophylaxis:
Laboratory Hazards
Laboratory-Acquired Infections (epidemiology of lab-acquired infections):
Sources/Specimens:
Primary Hazards:
Special Hazards:
Recommended Precautions
Containment Requirements:
Personal Protective Equipment:
EHS Form (06-11)
Risk Assessment Worksheet
Other Precautions:
Handling Information
Spills:
Disposal:
Storage:
Miscellaneous Information/References
Congratulations! You now have a material safety data sheet for your biological agent.
EHS Form (06-11)
Risk Assessment Worksheet