University of Texas Medical Branch

UNIVERSITY OF TEXAS MEDICAL BRANCH

Notification of Use (NOU)

Biological Agents, Recombinant Materials, CDC and USDA Regulated Agents

The purpose of this document is to ensure adequate review of occupational health and safety precautions and the procedures for use, handling, storage and disposal of biohazardous agents. The Principal Investigator (P.I.) or Supervisor must be fully aware of the potential hazards associated with the agent(s) used in the work area.

THIS MAY BECOME A PUBLIC DOCUMENT: DO NOT INSERT PROPRIETARY OR SECURITY SENSITIVE INFORMATION.

Type of Submission: New Renewal Amendment (NOU #: )

Type of Agent: Biological Agent Recombinant Material

Select Agent: Yes No

Animals: Yes No Transgenic

Biosafety Level at which this agent will be used: BSL1 BSL2 BSL3 BSL4

(One Biosafety level per NOU.)

Select the Risk Group (RG) for this agent: RG1 RG2 RG3 RG4

(RG definitions:http://oba.od.nih.gov/oba/rac/guidelines/nih_guidelines.htm#_APPENDIX_B._CLASSIFICATION)

I am familiar with and agree to comply with the UTMB Safety Manual, the UTMB Institutional Handbook of Operating Procedures (IHOP), the CDC/NIH Biosafety in Microbiological and Biomedical Laboratories (most current edition) and the NIH Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules.

The information provided in this document is accurate to the best of my knowledge. I agree to abide by the provisions set forth in this plan as approved by the University of Texas Medical Branch Institutional Biosafety Committee.

I accept responsibility for training all laboratory workers involved in the research project described in this "Notification of Use" before commencement of work.

P.I. (Signature) / Title / Extension /
Date Submitted
P.I. (Printed Name) / UTMB ID# / Department /
Route
Co-P.I. (Signature) / Title / Extension /
Date Submitted
Co-P.I. (Printed Name) / UTMB ID# / Department /
Route

Institutional Biosafety Committee Use Only

______
Date Approved Date for Resubmission NOU Number
A B C D1 D2 D3 D4 D5 D6 D7 E F
NIH categories
______
IBC Chairman Signature Print Name