Local Risk Assessment Worksheet for Work with Biological Materials

Completed By: Enter text here. / Date Completed: Enter text here.

Material Description

  1. Name or Description of material being handled:

Enter text here.
  1. Is material considered pathogenic: ☐ Yes ☐ No

If Yes… / If No…
Indicate Risk Group: ☐ 1 ☐ 2 ☐ 3
How was risk group determined?
  • ☐Pathogen data sheet
  • ☐By supplier or other researcher
  • ☐Pathogen risk assessment
  • ☐Other:
/ Indicate why it is considered non-pathogenic:
  • ☐Material comes from an otherwise healthy individual; or,
  • ☐Material comes from the environment in an unaltered state: or
  • ☐Other:Enter text here.

Personnel Factors

  1. Vaccine available?
/ ☐Yes - Name of vaccine: / ☐No☐N/A
  • All personnel working with or near any of the above material in use have been:

Offered any available vaccinations and the department has a record of the vaccination being received OR declined with counselling. / ☐Yes ☐ No
Is a medical surveillance plan in place and documented. Please Describe:
Enter text here. / ☐Yes ☐ No
Is a Medical Contact Card required? / ☐Yes ☐ No
Instructed in signs and symptoms of infection / ☐Yes ☐ No
  1. PPE required when working with agent (check all that apply)

☐Face shield / ☐safety glasses / ☐N-95 / ☐face mask
☐back-closing gown at BSC

*Note: labcoat, close toed shoes, and gloves are all mandatory for all microbiological work!

  1. Frequency of contact with agent: ☐Routine/daily ☐Weekly ☐Random/monthly /yearly

Assessment of Factors Associated with the Specific Work Processes

  1. Concentrations and volumes used:

Largest single volume used:
☐< 1Litres ☐1-10Litres ☐>10Litres / Indicate volume if greater than 10 L
Indicate concentrations used (If concentrated enter both before and after concentrations): / Enter text here
Indicate concentration required to cause infection: ☐N/A / Enter text here
  1. Is all work with the active agent done in a BSC?( not required for CL1 ) ☐Yes ☐No
  1. Is bench work completed on agent? ☐Yes ☐No

Is material inactivated prior to manipulation?
☐Yes ☐No / If NO, indicate type of procedures done on open bench (refer to SOPs used): Enter text here
How will the hazards of exposure by bench workbe mitigated? / Enter text here
Will any process performed on the bench create aerosols?
☐Yes ☐No / If YES, indicate how exposure to aerosols will be minimized:Enter text here
  1. Will sharps be used?☐Yes☐No

If YES, are you using safety engineered sharps? If not, explain:Enter text here
  1. Processes that increase exposure potential should be identified. Do you use any of the following processes (check all that apply):

☐Cell sorting / ☐Sonication / ☐Centrifuging in open containers
☐Blending / ☐Flaming loops / ☐Shaking or vigorous mixing
☐Grinding / ☐Pipetting / ☐homogenizing
☐Opening containers with high internal pressures
☐Other procedures that may create an airborne exposure to a pathogen: Enter text here
  1. Will your experiments involve centrifugation? ☐Yes ☐ No
  2. IfYES, are sealed rotors, or sealed centrifuge safety cups available for use? ☐Yes ☐ No
  3. If NOto “10 a”, do you only use screw –cap non-glass tubes? ☐Yes ☐ No
  4. Will you open the tubes in the BSC after centrifuging? ☐Yes ☐ No

If YES, click here to explain how you will protect against exposure.

Disinfection and Waste Disposal

  1. At what stage of your work will the infectious agent be inactivated or lysed? ☐N/A

Enter text here – note N/A should only be used if there is no infectious agent. /
  1. Specify disinfectants and decontaminants and decontamination procedures in use: ☐N/A

Disinfectant / Working Concentration / Contact Time (min) / Preparation Frequency / Used Against
Enter text here. / Enter text here. / Enter text here. / Enter text here. / Enter text here. /
Enter text here / Enter text here / Enter text here / Enter text here / Enter text here /
Enter text here / Enter text here / Enter text here / Enter text here / Enter text here /
  1. Complete the table to identify how biohazardous wastes generated by your research are treated (Any autoclaving and direct disposal requires weekly efficacy logs):

Waste Generated and disinfection process / Disinfection Parameters
☐Yes ☐No ☐N/A / Solid waste contaminated with biohazardous material and all microbial and eukaryotic cell cultures, including broth cultures.
Disposal by:
☐Biowaste bin (UW Disposal Service) or ☐Autoclaving / ☐N/A
Autoclave temp & time
Enter text hereoC
Enter text heremin.
☐Yes ☐No ☐N/A / (Sharps) Needle and syringe assemblies will be
Disposed by:
☐Biowaste sharps bin (UW Disposal Service) or ☐Autoclaving / ☐N/A
Autoclave temp & time
Enter text hereoC
Enter text here min.
☐Yes ☐No ☐N/A / Used glass and hard plastic pipettes and Pasteur pipettes will be:Disposed by:
☐Biowaste sharps bin (UW Disposal Service) or ☐Autoclaved and disposed as regular waste / ☐N/A
Name of Solution
Enter text here
Contact time
Enter text here hrs
☐Yes ☐No ☐N/A / Liquid waste contaminated with biohazardous material will be
Disposal by:
☐Biowaste bin (UW Disposal Service) , ☐Autoclaving,
☐Chemically / Enter Autoclave temp and time OR chemical contact time here.
☐Yes ☐No ☐N/A / Other, specify: Enter text here / Enter text here

Summary:

Summarize the SOPs or describe the processes you will be using to minimize risk. Use reference numbers or naming conventions that you use in your lab, and provide a short description of its purpose. These must be made available to the Biosafety Officer upon request.

Identify SOPs or Controls used for your work
Example – SOP 734 – Purification of xxx by centrifugation….
Enter text here
Enter text here
Enter text here
Identify Controls used for your work
Enter text here

Safety Office Comments:

Supervisor Name:
Signature: / Date:
Biosafety Officer Name:
Signature: / Date:

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September 2015 Version 2