Institutional Biosafety Committee

University of Vermont

Request for Change in Principal Investigator or Key Personnel

A. / IBC Protocol Information
IBC #: / Principal Investigator (PI):
Protocol Title:
Biosafety Level: / BSL1 / BSL2 / BSL2+ / BSL3
B. /
Change in Principal Investigator
/ /
Not Applicable
B.1 PI Name / Email Address
B.2 Faculty Sponsor (If New Principal Investigator is non-faculty, this section needs to be completed.)
Faculty Sponsor Signature and Date / Faculty Sponsor Name Printed
C. / Add Other Key Personnel / Not applicable
PLEASE DO NOT SUBMIT THIS REQUEST UNTIL ALL KEY PERSONNEL ADDITIONS HAVE COMPLETED THE REQUIRED TRAINING This includes BSL2 class training if applicable
Check training completions at http://riskmgmt.w3.uvm.edu/transcripts/UserLookup.php
Last Name
/
First Name
/
UVM Net ID
C.1 Is there an associated IACUC or IRB protocol?
/ /
Yes
/ /
No
*If yes, personnel must be added as key personnel to the IACUC or IRB protocol as well and complete required training
D. /
Remove Personnel
/ /
Not applicable
Last Name
/
First Name
Should this person be removed from any of your other protocols? / Yes / No
If yes, list the other IBC file numbers below.
If this person is the protocol’s primary contact, please assign a new contact below.
E. /
New Principal Investigator Agreement (sign if new PI otherwise proceed to F)
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 (indicated by CDC/NIH) applicable to this project. I agree all faculty, staff, and students working on this project will follow these recommendations as a condition of the Institutional Biosafety Committee approval of this project.
I agree to comply with the requirements specified by the NIH Guide for Grants and Contracts Pertaining to Shipment and Transfer of Recombinant DNA Materials, including requirements specified by the IATA Guide for Shipment of Infectious Substances and/or Diagnostic Specimens.
I agree to accept responsibility for training and safety of all the laboratory workers involved in the project and assure that all research personnel are familiar with and understand the potential biohazards and relevant biosafety practices, protective equipment and techniques, and emergency procedures.
Signature of the New Principal Investigator / Date
F. /
Principal Investigator Signature
Signature of the Principal Investigator / Date

Research Protections Office, 213 Waterman Bldg, 85 South Prospect St, Burlington, VT 05405, (802) 656-5040

personnel_change - 06/29/17 Page 1