Biohazard Permit Main Application (Risk Group 2) Version 1.0; March 2019 Directions: Submit Form This form is to be completed for work involving Risk Group 2 (RG2) materials and/or both Risk Group 1 (RG1) and RG2 materials. For e.g., if you have three RG1 & one RG2, complete this RG2 application form. Projects involving RG 1 materials only are to be registered using the BSC-11 Risk Group 1 application. Applications for storage only of biohazardous materials are to be registered using the BSC-13 Storage application form. Note: Projects/program with similar risk group/containment level and/or scope or intent of research can be consolidated as a single biohazard application. How to submit: Use the Submit button feature OR Email completed form to [email protected]. Use attach file button to attach docs or submit each doc as an individual file – do not merge. Pdf or Word or Excel files are suitable file types. Paper copies are not required. In the event of insufficient space in any section, please attached additional pages as necessary, labelled with the section number. 1. General Information Does this application replace an existing Biohazard Permit? ☐No ☐Yes. Please provide previous permit number: ____________________________ Proposed start date: _____________________ Proposed completion date: _____________________ 2. Principal Investigator Principal Investigator (PI) Department Phone extension Email For first time biohazard permit applicants, the PI’s background regarding work with biological materials covered under the Biosafety program (microorganism, cell lines, recombinants, etc.) is to be included. Please indicate by checking any one of the boxes below. ☐ Not applicable (previous biohazard permit holder at the University of Guelph) ☐ Curriculum Vitae (CV) Attach CV ☐ Link to relevant experience/background provided. E.g. Faculty webpage. Link: 3. Program Summary (Research, Teaching Course or Diagnostic Program) Using plain language, please provide an overview of the research, teaching course or diagnostic program.
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Biohazard Permit Main Application (Risk Group 2)
Version 1.0; March 2019
Directions: Submit Form This form is to be completed for work involving Risk Group 2 (RG2) materials and/or both Risk Group 1
(RG1) and RG2 materials. For e.g., if you have three RG1 & one RG2, complete this RG2 application form.
Projects involving RG 1 materials only are to be registered using the BSC-11 Risk Group 1 application.
Applications for storage only of biohazardous materials are to be registered using the BSC-13 Storage
application form.
Note: Projects/program with similar risk group/containment level and/or scope or intent of research can
be consolidated as a single biohazard application.
How to submit:
Use the Submit button feature OR Email completed form to [email protected].
Use attach file button to attach docs or submit each doc as an individual file – do not merge.
Pdf or Word or Excel files are suitable file types. Paper copies are not required.
In the event of insufficient space in any section, please attached additional pages as
necessary, labelled with the section number.
1. General Information
Does this application replace an existing Biohazard Permit?
☐No ☐Yes. Please provide previous permit number: ____________________________
This project involves inoculation of biohazards into animals:
☐ No ☐ Yes. If yes, provide AUP #:
This project involves human subjects:
☐ No ☐ Yes. If yes, provide approval #:
This project involves the use of radioisotopes:
☐ No ☐ Yes. If yes, provide permit #:
6. Biohazardous Materials
Please refer to the Biosafety Program for materials included within the Program. Previous bohazard permit holders, must attach BSC- 9 Pathogen status update inventory form. Complete
6.1 Microorganisms ☐ Applicable ☐ Not applicable
View BSC -9 form
☐ Attach BSC - 9 ☐ Linked:
Microorganisms (include bacteria, fungi, viruses, and parasites (protozoa and helminths). Specify all that apply. Refer to ePATHogen database for human and animal pathogen classification.
Complete Form BSC-1 for each/multiple similar organism(s). Multiple species sharing the same
properties can be listed on a single BSC- 1 form. Strains of the same species sharing the same
properties should be grouped accordingly. Attach BSC -1 form (s)
Microorganism Type Risk Group Classification Proposed Lab
6.7 Environmental samples ☐ Applicable ☐ Not applicable Attach BSC -1 form(s)Environmental samples include soil, plant or food, etc. on which microbiological analysis
including culturing, isolation, testing and/or enrichment of samples will be done.
Complete BSC-1 Form for each or multiple similar RG2 microorganisms.
Sample type (e.g. soil) Potential microorganisms Risk
Group
Proposed
Containment
Level
7. Location
7.1 University of Guelph sites
Please provide information regarding your work locations with biohazards at University sites below. Buildings included in the drop-down menu are those included in the University’s Pathogens and Toxins License. Other University of Guelph locations are not currently approved for RG2 work. Please describe any other locations in the text field below. Note that small and large animal rooms in the Isolation building (#46) have appropriate eyewash and safety showers available.
Building Name Room
Number
Room Type Shared Space Eyewash Safety shower
Choose an item. Choose an item. Choose an item. ☐ ☐
Choose an item. Choose an item. Choose an item. ☐ ☐
Choose an item. Choose an item. Choose an item. ☐ ☐
☐ Eyewashes are flushed weekly
☐ Person has been designated as responsible for weekly eyewash flushing
If you chose “other” under building name, or room type in the table above, please describe:
If yes, then contact BSO and complete the remaining questions in this section. If not, continue to
Section 19.
i. Will the pathogen(s) acquire any of these potential hazards?
☐ increase in virulence
☐ production of novel toxin
☐ enhance communicability or transmissibility
☐ alteration of host range
☐ interfere, by-pass or diminish the effectiveness of diagnostic tools and therapeutic or
prophylactic antimicrobial or antiviral treatments
☐ enhance capacity for spreading or for easy release or making them “weapons-grade”
ii. Is there a potential for research knowledge (e.g., data, methodology, results), technology, intermediate and final products (e.g., toxins) to be misused? Explain:
iii. If released, will the pathogen or research information pose threat to any of the following? Select all that apply:
☐ aquatic animals, invertebrates
☐ terrestrial animals
☐ humans
☐ public safety
☐ national security
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Version 1.0; March 2019
19. Principal Investigator’s Certification
I certify that the information provided in this protocol application form is accurate and that any protocol
changes will be submitted to the Biosafety Committee for approval prior to initiation.
I certify that I have read and will comply with the University of Guelph’s Biosafety Policy.
I certify that I agree to conduct the work in accordance with the University of Guelph’s Biosafety
program, Canadian Biosafety Standard and any other applicable legislation or requirement, including
conditions of the Biohazard Permit.
I accept responsibility for training of all laboratory, animal care, and support personnel involved in work
described in this application project and personnel sharing space and/or equipment on potential
biohazards, relevant biosafety practices, techniques, emergency procedures, and incident reporting.
I will submit a written report as per University procedures concerning any related incident, exposure, loss
or release of biohazards; any problems associated with biological and physical containment procedures,
or violations in the University Biosafety program
I agree to comply with all conditions in the permit and that the Biosafety Committee will initiate no work
prior to project approval. I accept responsibility for the safe conduct of the work and I will inform all
personnel who may be at risk of exposure to the biohazardous materials of potential hazards associated