Atlanta VAMC

rDNA Registration Form

Project Title:

Principal Investigator:

Names of any Co-Investigators:

Key Words: Please select all key words that apply to this registrationonly for projects that are using rDNA.

Request for rDNA RegistrationVersion Date 1/31/2013Page 1 of 3

Prokaryote/Bacteriophage

Plasmids

Eukaryotic organisms

Non-human mammalian cell lines

Human cells/tissues/blood

Animal Cell Lines

Use of Transfected/Transgenic Animals

Adenovirus / Adenoviral

Adeno-Associated Virus (AAV)

Retrovirus / Retroviral

Lentivirus / Lentiviral

Eukaryotic viruses

Request for rDNA RegistrationVersion Date 1/31/2013Page 1 of 3

Note: If any material used for experiments was obtained under a Material Transfer Agreement (MTA), please attach a copy of the agreement to the end of this registration.

  1. Provide a non-technical description of the proposed work below (explaining all acronyms).

Your abstract should explain in layman’s terms what you are going to do with the recombinant DNA. Give a brief narrative of the goals and experimental procedure so as to provide a basis for review.

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  1. What sequences will be used?

List each sequence individually (Name, Function, Species of origin)

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Does anysequence encode all or part of a toxin or oncogene?Yes, No

  1. How will DNA be propagated?

List the vectors (plasmid, phage and/or eukaryotic viral vectors) to be propagated, the source, and the host used for propagation. Vectors for prokaryotic and eukaryotic hosts should be listed separately.

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Will you be growing cultures in ≥10L?Yes, No

  1. Describe the proposed experiments in detail.

Include manipulation and analysis of cells or organisms transformed, transfected or infected with rDNA vectors.

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  1. Will there be expression of a protein or regulatory RNA?Yes, No

If yes explain:

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  1. Do you anticipate transfer to humans or animals?Yes, No

If yes explain:

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  1. Will the project involve the generation of transgenic or knockout animals? Yes, No

If yes explain:.

  1. Will other laboratories or core facilities be involved or will materials be transported between labs?Yes, No

If yes explain:

  1. Perform a Risk Assessment and describe the biohazard potential of these experiments.

For example, what effect might there be if a vector expressing your inserted genes were inadvertently introduced (via abrasion, injection or ingestion) into and expressed in a lab worker?

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  1. Address how you will mitigate the potential hazards.

Describe the facilities and engineering controls, the precautions (i.e. spill kit and signage) and any personal protective equipment that will be used to maintain the proper biosafety level containment. Also, describe how infectious materials will be packaged if transported between labs. Testing of replication deficient organisms for reversion.

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  1. Will any special health surveillance be required?Yes, No

Consider the necessity for using an N95 respirator (fit testing required), vaccinations, storage of a pre-exposure serum sample, etc.

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  1. Describe how laboratory waste from these experiments will be managed.

Describe the laboratory will manage and dispose of waste materials including autoclaving as necessary.

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  1. Describe how you will clean and decontaminate work surfaces and equipment utilized in the experiments.

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  1. Training.

Provide information on the relevant experience the PI and all applicable personnel have in relation to the proposal (work with organisms, viruses, BSL2 work, etc.) or, if applicable, describe the training the PI and/or personnel will receive.

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  1. Will any rDNA be shipped? Yes, No

If yes, the PI must agree to comply with the shipment requirements for rDNA as indicated in Appendix H of the Guidelines.

  1. Please specify the classification that you think appropriate.

A simplified list of classifications including examples is available on the P drive in P:\Documents\151\RESEARCH FORMS\Biosafety and Biosecurity\rDNA Committee

IIIA, IIIB, IIIC, IIID, IIIE, IIIF

  1. Suggested biosafety level.

BSL-2, BSL-3, ABSL-1, ABSL-2 ABSL-2-Ni, ABSL-3

To the best of my knowledge, the information provided above is accurate and complete.

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Principal InvestigatorDate

(For use by Research Office)

Reviewed by IBC/SRS Committee and approved.

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Chair IBC/SRS CommitteeDate

Request for rDNA RegistrationVersion Date 1/31/2013Page 1 of 3