|
Several
forms have been developed in order to assist the Principal Investigator
with the required submissions and filings required by the federal regulatory
agencies that have jurisdiction over research activities. The following
instructions are provided to assist you in completing these forms.
These forms are provided in Microsoft Word. Except where
otherwise noted, you may fill out the gray text areas and checkboxes
in Microsoft Word. Then you will need to print the forms, fill out any
fields that require manual input (e.g., signature), and submit them.
Form OHS-1 Occupational Health and Safety Questionnaire (Microsoft Word)
This Form is an internal document to be used for reporting animal related health issues such as hazards, bites, allergic reactions or sequelae you may feel are related to the direct handling of animals. Since information collected on this form is HIPAA-sensitive, all submissions will be kept in strictest confidentiality, and will only be available to the BioSafety Officer, Employee Health Service, and the USDA on demand. USDA is the federal agency requiring this activity, and it is a MANDATORY submission for any and all individuals working with vertebrate animals more than 5 hours per week. All individuals listed on IACUC Form 1, Section 3. “Co-Investigators and Other Personnel,” http://www.mssm.edu/iacuc/forms.shtml, must have a separate, signed OHS form filed with the BioSafety Officer annually.
Form BSO-1 Report of Laboratory Accident (Microsoft Word)
If YOU have had an accident / exposure, you are required to report the
incident if it involves HUMAN blood / body fluids. The purpose of the
report is to provide documentation that the illness that may develop
as a consequence of the incident is work-related.
http://www.osha-slc.gov/OshStd_data/1910_1030.html
Form BSO-2 Certificate of Decontamination (Microsoft Word)
OSHA and EPA regulations require that any analytical equipment
freezers, refrigerators, incubators that were used with infectious agents or Human blood or body fluids receive decontamination prior to disposal or return to manufacturer or a service company. This form is used to record the date and method of decontamination and provide tracking documentation in the event of an inquiry by one of these agencies.
http://www.osha-slc.gov/OshStd_data/1910_1030.html
Form BSO-3 Laboratory Self-Inspection Form Biohazard Precautions (Microsoft Word)
This form is used to self-appraise your compliance activities in the laboratory or to self-report Biosafety Levels to the BioSafety Officer when required by a Funding Agency. Based on the CDC’s Biosafety in Microbiological and Biomedical Laboratories (BMBL) 4th Edition, it addresses the major points of the Biosafety levels 1 and 2 as described in the CDC's BMBL http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm and the NIH Guidelines
http://www4.od.nih.gov/oba/rac/guidelines_02/Appendix_G.htm.
Form 1 / 2005 MSSM - IBC Certificate of Registration (Microsoft Word)
This Form is an internal document to be used for reporting recombinant DNA activities to the Institutional BioSafety Committee as required by the NIH Guidelines. All experiments that require notification before initiation and simultaneously with initiation are reported on this form. Major Action Activities, Gene Therapy submissions are not reported externally to the NIH or FDA on this form.
http://www4.od.nih.gov/oba/rac/guidelines_02/NIH_Guidelines_Apr_02.htm#_Toc7261560
Standard Biohazard Warning Form (Microsoft Word)
You may fill out this Microsoft Word form on your computer by tabbing through the form fields, or you may print the form out and fill it in by hand. Please note that you should print the form out on a color printer.
|
