IBC Registration
Section A – General Information

IBC #:

For EHS Use Only
Submission Date:	IBC Approval Date:	Biosafety Level:	Expiration Date:
A review of training records has been completed.

The purpose of IBC Registration is to identify, assess, and mitigate the risk associated with biological work being conducted in laboratories at George Mason University (Mason). An IBC registration form must be completed for all research and instructional protocols involving the use of biological materials. Registrations must be submitted two weeks prior to the IBC meeting (usually held the first Friday of each month) in order to be reviewed at that meeting.

PART 1 – CONTACT INFORMATION
1.	Principal Investigator (PI)/Course Coordinator:	Title/Position:
2.	Office Phone:	Alternate Phone:	Email:	Campus Address (Building, Room #, & MSN):
3.	Department/Unit:	Department Chair:

PART 2 – CO-PI / COLLABORATOR INFORMATION
1.	Co-PI and/or collaborators are involved with this protocol. If yes, provide their contact information below.
1a.	Name:	Institution:	Phone:	Email:
1.b	Name:	Institution:	Phone:	Email:
1.c	Name:	Institution:	Phone:	Email:

PART 3 – PROTOCOL INFORMATION
1.	Protocol Title:
2.	This protocol is a:	New Protocol; or Renewal, indicate previous protocol number ; or Modification, complete Section G.
3.	Protocol Type:	Research Instructional Graduate Student/Thesis Other, specify:
4.	List all funding agencies and grants for this protocol. Include the fund/grant number:
5.	List all locations where the experiments associated with this protocol will be conducted. Include the building(s) and room number(s).
6.	Indicate any other committee reviews that have or will take place.
Committee	Protocol Number	Approval Date	Institution
6.a	Institutional Biosafety Committee
6.b	Institutional Review Board (IRB)
6.c	Institutional Animal Care and Use Committee (IACUC)
6.d	Institutional Review Entity for Dual Use Research of Concern (IRE)
6.e	Radiation Safety Committee (RSC)
6.f	Other:

PART 4 – PROTOCOL DESCRIPTION
1.	Provide a purpose and summary of the protocol in lay terminology. The description must be understandable to nonscientists.
2.	Describe the protocol with sufficient detail that the committee can follow the steps involved and the work flow of the protocol and are able to evaluate the controls in place to safely conduct work.

PART 5 – MATERIALS
1.a	The protocol involves infectious agents. If yes, complete Section B.
1.b	The protocol involves other potentially-infectious materials (e.g., human or nonhuman primate blood and body fluids, established cell lines, primary cell lines). If yes, complete Section C.
1.c	The protocol involves recombinant or synthetic nucleic acid molecules. If yes, complete Section D.
1.d	The protocol involves viral vectors. If yes, complete Section D.
1.e	The protocol involves transgenic plants or animals. If yes, complete Section D.
1.f	The protocol involves biologically-derived toxins. If yes, complete Section E.
1.g	The protocol involves live vertebrate animals. If yes, complete Section F.
1.h	The protocol involves field work.
1.i	The protocol involves invertebrates. Specify:
1.j	The protocol involves Risk Group 1 agents or materials handled at BSL-1. (https://my.absa.org/Riskgroups.) Specify:
1.k	The protocol involves preserved animal specimens. Specify:
1.l	The protocol involves whole plants or preserved plant specimens. Specify:
1.m	The protocol involves other. Specify:

PART 6 – PROCEDURAL HAZARDS AND CONTROLS
1.	Will any of the following manipulations be conducted? Check all that apply, and describe how risk(s) from each type of manipulation will be contained.
1.a	Homogenization Risk Contained:	1.k	Blending Risk Contained:
1.b	Centrifugation Risk Contained:	1.l	Shaking Risk Contained:
1.c	Aspiration Risk Contained:	1.m	Vortexing Risk Contained:
1.d	Pipetting/Micropipetting Risk Contained:	1.n	Generation of an Aerosol Challenge Dose, Risk Contained:
1.e	Filtration Risk Contained:	1.o	Other Aerosol-Generating Procedures. Specify: Risk Contained:
1.f	Chromatography Risk Contained:	1.p	Procedures under vacuum or pressurized (including storage and experimental conditions)? Specify: Risk Contained:
1.g	Cell Sorting Risk Contained:	1.q	Use of Sharps (e.g., syringe needles, scalpels). Specify: Risk Contained:
1.h	Sonication Risk Contained:	1.r	Use of Glass Containers. Specify: Risk Contained:
1.i	Grinding Risk Contained:	1.s	Use of Flip-Top Storage Tubes (e.g., Eppendorf tubes). Risk Contained:
1.j	Heating material to high heat and/or for an extended period of time. Specify: Risk Contained:

PART 7 – PERSONAL PROTECTIVE EQUIPMENT
Which of the following types of personal protective equipment will be utilized? Check all that apply.
Nitrile gloves	Static-free gloves	Double gloves
Laboratory coat	Solid front gown	Booted coveralls
Sleeve covers	Shoe covers	Safety glasses
Safety goggles	Face shield	Surgical mask
N95 or N100	Clothing for fieldwork. Specify:
Powered Air Purifying Respirator (PAPR)	Other. Specify:

PART 8 – DISINFECTION/DECONTAMINATION/WASTE DISPOSAL
1.	List the disinfectant, concentration, and contact time used to decontaminate each of the following.
Item	Disinfectant	Concentration	Contact Time	Decon Frequency
1.a	Surfaces and Equipment
1.b	Liquid Waste
1.c	Spills
1.d	Other:
2.	List the method used to treat (autoclave, burn box, chemical disinfection) each of the following.
Type	Treatment Method
2.a	Solid Waste
2.b	Sharps Waste
2.c	Carcasses
2.d	Other:

PART 9 – SHIPPING AND TRANSFER
1.	Do you intend to export materials related to this protocol? If yes, specify:
2.	Do you intend to import materials for use in this protocol? If yes, specify:
3.	Do you intend to transfer materials included in this protocol across state lines? If yes, specify:
4.	Do you intend to ship material included in this protocol from your lab to an offsite location? If yes, specify what material you plan to ship:

PART 10 – LABORATORY PERSONNEL (INCLUDING PI/CC)
1.	Provide qualifications and experience with regard to specific procedures that each person will perform. If there aren’t enough rows below to list all laboratory personnel, then please submit the information in a separate document.
Name	Position or Title	Background and Experience

PART 11 – LABORATORY INFORMATION
1.	An updated and accurate record of infectious agents and toxins is available to laboratory workers at all times, and to EHS upon request. If yes, specify location of inventory record(s):
2.	The inventory record is reviewed and updated at least annually and when material is acquired or removed.
3.	The inventory record has been updated to reflect material listed in this protocol.
4.	A Supplemental Laboratory Safety Plan is on file in the laboratory and laboratory workers received training on the contents of the plan.
5.	How the building, where material is used or stored, is controlled? Check all that apply.
Lock and key	Electronic access control (card)	Pin code
Biometric system	Guards:	None
Other:
6.	How the laboratory, where material is used or stored, is controlled? Check all that apply.
Lock and key	Electronic access control (card)	Pin code
Biometric system	Other:
7.	How is access restricted to storage units (refrigerator, freezer, etc.) where material is stored? Check all that apply.
None	Lock and key	Locked storage box	Other:
8.	A sink is present in the laboratory for handwashing.
9.	An eyewash station is readily available.
10.	A biosafety cabinet is available and operational with current certification.
11.	Recommended Containment (Biosafety) Level: Check all that apply. (For definitions of each biosafety level, visit http://www.cdc.gov/biosafety/publications/bmbl5/BMBL5_sect_IV.pdf.
BSL-1	BSL-2	BSL-3	ABSL-1	ABSL-2	ABSL-3

PART 12 – PI ACKNOWLEDGEMENT OF RESPONSIBILITY
Principal Investigators (PIs) are responsible for full compliance with the NIH Guidelines and George Mason University policies and procedures during the conduct of recombinant or synthetic nucleic acid molecule research, work with infectious or potentially-infectious material, and biologically-derived toxins. Please read each statement. The PI must acknowledge these responsibilities by marking the checkbox below. Be adequately trained in good microbiological and molecular techniques. Provide laboratory staff with protocols describing potential biohazards and necessary precautions. Instruct and train laboratory staff in: (i) the practices and techniques required to ensure safety, and (ii) the procedures for dealing with accidents. Inform the laboratory staff of the reasons and provisions for any precautionary medical practices advised or requested (e.g., vaccinations). Supervise laboratory staff to ensure that the required safety practices and techniques are employed. Correct work errors and conditions that may result in the release of recombinant or synthetic nucleic acid molecules, infectious material, potentially-infectious material, or biologically-derived toxins. Ensure the integrity of physical containment (e.g., biological safety cabinets) and biological containment (e.g., host-vector systems that preclude survival of the agent outside the laboratory). Comply with permit and shipping requirements for recombinant or synthetic nucleic acid molecules, infectious material, potentially-infectious material, or biologically-derived toxins. Adhere to IBC-approved emergency plans for handling accidental spills and personnel contamination. Before initiating research with recombinant or synthetic nucleic acid molecules, infectious or potentially infectious material, and biologically derived toxins, the PI must: Determine whether the research is subject to Section III-A, III-B, III-C, III-D, or III-E of the NIH Guidelines. Propose physical and biological containment levels when registering research with the IBC. Propose appropriate microbiological practices and laboratory techniques to be used for the research. Submit a research protocol to the IBC for review and approval. Obtain IBC approval before initiating research. Seek NIH approval, in addition to IBC approval, to conduct experiments specified in Sections III-A and III-B of the NIH Guidelines. While conducting research with recombinant or synthetic nucleic acid molecules, infectious or potentially-infectious material, and biologically-derived toxins, the PI must: Submit any subsequent changes (e.g., changes in the source of DNA or host-vector system) to the IBC for review and an approval decision. Remain in communication with the IBC throughout the duration of the project. Report any significant problems pertaining to the operation and implementation of containment practices and procedures, violations of the NIH Guidelines, or any significant research-related accidents and illnesses to the IBC or EHS. Checking this box signifies that the PI accepts the above responsibilities, and that the PI will ensure that laboratory personnel will comply with George Mason University policies and procedures, and all protocols contained within the approved version of this registration, including any additional sections.