Biological Safety Forms

Documents associated with Biological Safety
Titlesort descending Description File Name
Bloodborne Pathogens: At Risk Assessment

This form is to assist in the identification of staff at risk for exposure to bloodborne pathogens or other potentially infectious material.

Binary Data
Hepatitis B Vaccination Survey

This survey is to be completed when consenting or declining to receive the Hepatitis B vaccination.

PDF icon Hepatitis B Vaccination Survey Instructions
Human Pluripotent Cell Application

This form should be used to register all use of human embryonic stem cells and/or human pluripotent cells.

Microsoft Office document icon Human Pluripotent Cell Application
Select Agent Registration - Internal Form

Use this form to apply for use of select agents in the CCOM BSL3 laboratories.  The form must be submitted to Haley Sinn, BSO in the Environmental Health & Safety Office, 100 EHS.

Microsoft Office document icon SA Internal Reg Form.doc
Select Agent Toxin Exemption Declaration

This document is a list of select agent toxins and their exempt quantity limits and must be signed by each Principal Investigator (PI) who possesses exempt quantities of CDC Select Agent Toxins to ensure the PI understands the allowable maximum exempt quantities s/he can possess, as specified by the federal regulations on Select Agents (42 CFR Part 73).

PDF icon PIexemptquantdeclaration.pdf
Select Agent Toxin Inventory Record Form

Inventory form for exempt quantities of select agent toxins.

PDF icon SelectAgentToxinInventoryRecord.pdf
Select Agent Toxin Transfer: Exempt Quantity

This document is to ensure each Principal Investigator (PI) who possesses exempt quantities of Select Agent Toxins understands the allowable maximum exempt quantities s/he can possess, as specified by the federal regulations on Select Agents (42 CFR Part 73); and that s/he only transfer exempt quantities of toxin if the receiver has a legitimate need (reasonably justified by a prophylactic, protective, bona fide research or other peaceful purpose) to handle or use the toxin(s).

PDF icon PIexemptquantTransfer.pdf
Select Toxin SOP Template

Template to assist UI labs in writing a lab-specific SOP for the possession/use of exempt quantities of CDC select toxins. 

File SelectToxinSOP.docx
Site-Specific - Bloodborne Pathogens

After completing the Bloodborne Pathogens e-learning course, the date of completion will be added to your training records found under “My Training” on the Employee Self Service site. Complete this site-specific form with your supervisor or designated work area trainer to verify that you have successfully completed EHS’s e-learning course.  Note: this form is to be maintained in the lab's safety/training records.

PDF icon Site-Specific - Bloodborne Pathogen Training
Site-Specific- Shipping Infectious Substances

After completing the Shipping Infectious Substances e-learning course, the date of completion will be added to your training records found under “My Training” on the Employee Self Service site. Complete this site-specific form with your supervisor or designated work area trainer to verify that you have successfully completed EHS’s e-learning course.  Note: this form is to be maintained in the lab's safety/training records.

PDF icon Site-Specific - SIS training
Site-Specific- Shipping with Dry Ice

After completing the Shipping with Dry Ice e-learning course, the date of completion will be added to your training records found under “My Training” on the Employee Self Service site. Complete this site-specific form with your supervisor or designated work area trainer to verify that you have successfully completed EHS’s e-learning course.  Note: this form is to be maintained in the lab's safety/training records.

PDF icon Site-Specific - Dry Ice training
Vaccinia Vaccination Form

Vaccinia Vaccination Accept/Decline form

PDF icon Vaccinia Immunization Packet.pdf