Download Biohazardous Materials/rDNA Summary Form

SUMMARY FOR GRANT SUBMISSIONS
RECOMBINANT DNA/BIOHAZARDOUS MATERIALS
NEOMED INSTITUTIONAL BIOSAFETY COMMITTEE
PI Name:
Granting Agency Name:
Title of Proposal:
______________________________________________________________________________________
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RECOMBINANT DNA
Please provide the following information regarding any recombinant DNA you are using in the above
mentioned proposal:
What is the name of the recombinant DNA sequence?
What is the name of the virus or plasmid used for constructing the recombinant?
Will more than 10L of cell culture per experiment be produced?
Yes
No
What is the source of the rDNA material you are using?
( i.e. name of vendor, name of colleague)
What is the room number where rDNA material will be used and stored:
______________________________________________________________________________________
BIOHAZARDOUS MATERIALS
Please provide the following information regarding any biohazardous materials you are using in the above
mentioned proposal:
What is the name and description of the biohazardous material(s):
(example: E. Coli- bacteria, nematoda – parasite, osteosarcoma- human tissue samples)
What is the source of the biohazardous material?
( i.e. name of the vendor, name of the colleague, etc.):
What is the room number where biohazardous material will be used and stored:
________________________________________________________________________________________________________
Statement of Understanding:
I understand if the above mentioned application is funded, I will be required to complete a full IBC application for formal
review/exemption of the rDNA experiments proposed in this application as well as for registration of other biohazardous
materials I may be using.
PI Signature:
Date:
_________________________________________________
____________________________
*Please attach this form to the back of your completed grant routing form prior to bringing to the ORSP. This form will then
be placed on the grants workflow and reviewed electronically by the Chair of the NEOUCOM IBC. You will receive an email when this form has been approved and authorization from the IBC has been given to submit this proposal. Proposals
may not be submitted to any funding agency prior to obtaining all required compliance committee authorizations (IRB, IBC,
RSC, IACUC).