Georgia Institute of Technology
IBC Applicationfor Georgia Tech Personnel Working at Off-Campus Site(s)
Instructions
Georgia Tech Personnel Working at Off-Campus Site with OBA-Registered facility
In cases where the Georgia Institute of Technology (GIT) faculty member or student is involved in work located at an off-campus site with anOffice of Biotechnology Activities (OBA) registered Institutional BiosafetyCommittee (IBC), the GTIBC may accept an approval statement from that other IBC, in lieu of performing a duplicate review. However, the GTIBC requires investigators to submit a copy of the IBC approved application from the other reviewing institution, a copy of that institution’s IBCapproval letter along with this application below.
Georgia Tech Personnel Working at Off-Campus Site without OBA-Registered facility
The current GT IBC application process must be followed.
Required Training
In accordance with the NIH Guidelines, Section IV-B-1-h, the Institutional Biosafety Committee requires that all personnel named in recombinant DNA (rDNA) registrations complete certain training. New rDNA registrations, revision requests, and continuing review applications will be screened by the Office of Research Integrity Assurance (ORIA) to ensure that all personnel have completed the training requirement before committee approvals will be issued. For further details, please visit:
Enroll In Occupational Health Program (OHP)
The institution where the research will be conducted may have additional OHP requirements. Everyone named on the protocol must enroll in the GT OHP, managed by Environmental Health & Safety:
Departmental Sign Off
This prepared IBC application is to be signed by the applicant’s department head or, in lieu of a written signature, department heads may send an email to tating that they are aware of the proposed work and concur with its submittal to the IBC.
For assistance, contact the Office of Research Integrity Assurance or
Note: The above instructions may be deleted before submitting this application to the IACUC.
Georgia Institute of TechnologyIBC Application
for Georgia Tech Personnel Working at Off-Campus Site
A. Administrative Data
GT Principal Investigator / Course Director:
Department:
Telephone:
Emergency Contact and Contact #:
Project Title:
Funding Source:
Office of Sponsored Programs (OSP) Number (Doc ID or Project number):
Off-Campus Institution:
Off-Campus PI:
Off Campus Registration #:
B. Personnel, Training and Qualifications
The institution where the work will be conducted may have additional training and Occupational Health and Safety requirements. All GT personnel must complete the training and Occupational Health and Safety requirements as described in Section D below (also on the GT IACUC website).
Principal Investigator:
Training plan or qualifications:
C. Study Objectives
If your study is only part of the approved IBC Registration at another institution, please state what part of the research you and your research team will be involved in. If you will be involved in the full research protocol approved at another institution just state “full protocol.”
D. Certifications and Signatures
TRAINING: All Principal Investigators, Co-Investigators, and students involved in this IBC Registration must complete training in accordance with the NIH Guidelines, Section IV-B-1-h. For further details, please visit:
OCCUPATIONAL HEALTH AND SAFETY: Enrollment in the Occupational Health Program is also required for all personnel involved in research involving vertebrate animals and who handle biological materials or chemicals or are exposed to other health risks. Information regarding the completion of The Confidential Exposure/Risk Assessment Questionnaire form and the Occupational Health Program is available at:
Certification: I have read and am familiar with the standard and special microbiological practices, containment equipment, personal protective equipment, and laboratory facilities recommended for the biosafety level applicable to this project. I will ensure that all faculty, staff, and students working on this project will follow these recommendations as a condition of Institutional Biosafety Committee approval of this project.
Certification: As Principal Investigator, I acknowledge responsibility for this project and assure that the faculty, staff and students who participate in it are qualified and adequately trained to conduct the above research.
Signature of Principal Investigator: ______(PI may submit via GIT email for esignature)
Departmental Signoff
Name of Department Chair:
Signature of Department Chair: ______(Chair may submit via GIT email for esignature)
Georgia Institute of Technology IBC Application for Off-Campus Studies
Office of Research Integrity Assurance September 2014
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