INSTRUCTIONS FOR THE IBC APPLICATION FORM:
1. The IBC
Application Form must be completed and
submitted to the IBC for review prior to the initiation of all NMSU activities that
involve the use of Biohazardous
Agents or Recombinant DNA.
Form is to be filled out completely and submitted via campus mail to: IBC, c/o
EHS/MSC 3578 or submitted electronically to John Balog <jbalog@nmsu.edu>
Exceptions are listed below
- Research
applications involving Risk Group (RG) 1 and/or Biosafety
Level (BSL) 1 materials that do not involve
recombinant DNA do not require review by the IBC.
- Research using
any RG 4 agents or any materials that require BSL 4 containment will not be considered by
the IBC for work at any NMSU location or facility (dictated by the lack of qualifying
facilities at NMSU).
- The routine use
of most toxins and plant pathogens will not require IBC review and approval. However, the
possession, use, or transfer of any toxins or plant pathogens which are listed by the CDC
as a Select Agents (severe
threat to public health), or are on the USDA-APHIS Agent
and Toxin List (severe threat to
animal health/ products or plant health/products), will require IBC review and approval
prior to initiation of the project.
- The form must be
completed in its entirety, with all relevant worksheets and intra- and extra-
Institutional & Regulatory Approvals attached. See the CHECK LIST for Completion of the IBC
Registration Form below.
- Approval for
biosafety activities is granted for three years after the initial review by
the IBC. The Biosafety Officer will conduct annual inspections (Administrative Review) of
facilities of approved projects
- The PI must submit an
Activity Modification Report if and
when the project changes significantly in terms of experimental activities, facilities, or
for any personnel change, during the approval period.
- If the PI on a
project changes, a new application form must be submitted to the IBC.
- If any NMSU personnel associated with this activity physically
participate in an official capacity at a non-NMSU facility, the IBC approval documentation
from the non-NMSU facility must be included with the NMSU-IBC Application/Registration
Form.
CHECK LIST
for the
IBC Registration Form
(this form is for PI use and does not
need to be submitted to the IBC)
Return to Top of the Document
Location on
IBC Application Form |
* Required on all submissions
** Required
if corresponding box is marked
YES on the primary Registration
Form
***
see under NOTES
|
To
check a box electronically
hit
backspace, then Alt x or
hit
backspace and type an X
To
erase an Alt x, type Alt b
|
Page
1 |
SECTION
I |
ADMINISTRATIVE
INFORMATION
Principal Investigator Information*
Project Information*
Category of Application *
Funding Source Information* |
¨
¨
¨
¨ |
NOTES |
Page
1-2 |
SECTION
II |
INSTITUTIONAL & REGULATORY APPROVALS
Use
of Animals **
Use of Radiation **
Use of Human Subjects **
Federal Permits ** |
¨
¨
¨
¨ |
|
Page
2 |
SECTION
III |
LOCATION OF ACTIVITIES
NMSU*
Non-NMSU
** |
¨
¨ |
|
Appendices |
Supplement 1 |
Non-NMSU
facility additional space**
|
¨ |
|
Page
3
|
SECTION
IV |
TYPE OF BIOSAFETY ACTIVITY
Biohazardous
agents** |
¨ |
|
Appendices
|
Supplement 2 |
Biohazardous Agents additional space**
|
¨
|
|
Appendices
|
Worksheet 1 |
Select Agents **
|
¨
|
|
Appendices |
Worksheet 2 |
Biological
Agents and Toxins **
|
¨ |
|
Appendices |
Worksheet 3 |
Bloodborne Pathogens**
|
¨ |
|
|
|
Recombinant
DNA Molecules** |
¨ |
|
Appendices
|
Worksheet 4 |
Recombinant
DNA Experiments ** |
¨ |
|
Appendices
|
Supplement 2 |
Recombinant DNA additional space**
|
¨ |
|
Page
4
|
|
Risk
Group Assessment *
|
¨
|
|
Page
4 - 5 |
SECTION
V |
DESCRIPTION OF ACTIVITY
Lay Summary *
|
¨
|
|
Appendices
|
Supplement 3 |
Lay Summary additional space**
|
¨ |
|
|
|
Procedures *
|
¨ |
|
Page
6 |
SECTION
VI |
SAFETY
PLANS
Safety Plan* |
¨
|
|
Page
7 |
SECTION
VII |
ENVIRONMENTAL IMPACT
Environmental Impact * |
¨ |
|
Page
7 |
SECTION
VIII |
PERSONNEL
List
of Personnel * |
¨ |
A
personnel data form must be completed for each person on the List of Personnel |
Appendices |
Personnel
Data |
Personnel Data Form*** |
¨ |
Page
8 |
SECTION
XI |
PRINCIPAL
INVESTIGATOR STATEMENT
Principal Investigator Statement* |
¨ |
|
DEFINITIONS:
- Any
microorganism (including but not limited to bacteria, viruses, fungi, rickettsiae, or
protozoa), or infectious substance, or naturally occurring, bioengineered, or synthesized
component of any such microorganism or infectious substance that is capable of causing: 1.
death, disease or other biological malfunction in a human, an animal, a plant or another
living organism; 2. deterioration of food, water, equipment, supplies, or materials
of any kind; or 3. a deleterious alteration of the environment.
- Any toxic
material or product of plants, animals, microorganisms (including but not limited to
bacteria, viruses, fungi, rickettsiae, or protozoa), or infectious substances, or a
recombinant or synthesized molecule (whatever the origin and method of production), which
includes any poisonous substance or biological product that: 1. may be engineered as a result of biotechnology; 2. produced by a living organism; or 3. is an
isomer or biological product, homologue, or derivative of such a substance.
- Infectious or
pathogenic biological agent defined by: 1. CDC
as biosafety level (BSL) 2-4 (BMBL 4th Edition), or 2. NIH as risk group (RG) 2-4 agent (NIH
Guidelines April 2002) (also see
Additional Definitions on page 5 of this Charter document).
- Regulated
biological agent or toxin as identified by 1. HHS 42 Code of Federal Regulations (CFR)
Part 73 (Select Agents Program); 2. USDA-APHIS lists
of Biological Agents and Toxins that pose a severe threat to animal health or animal
products (9 CFR Part 121); or to plants health or plant products
(7 CFR Part 331) (Federal Register 9CFR 121 7CFR
331). Also see the NACUA
Agent and Toxin List as compiled by the National Association of College and University
Attorneys (NACUA), as a summary of all of the lists.
Return
to Top of the Document
Recombinant DNA
Nucleic acid molecules constructed outside
of living cells by joining natural or synthetic DNA segments to DNA molecules that can be
replicated in a living cell.
DNA molecules that result from the replication of those molecules
described above.
Return to Top of the Document
Risk Groups
Agents are classified into four Risk
Groups (RGs) according to their relative pathogenicity for healthy adult humans by the
following criteria: (1) Risk Group 1 (RG1)
agents are not associated with disease in healthy adult humans, (2) Risk Group 2 (RG2) agents are associated with
human disease which is rarely serious and for which preventive or therapeutic
interventions are often available, (3) Risk
Group 3 (RG3) agents are associated with serious or lethal human disease for which
preventive or therapeutic interventions may be available, (4) Risk Group 4 (RG4) agents
are likely to cause serious or lethal human disease for which preventive or therapeutic
interventions are not usually available. NIH recombinant DNA Guidelines Section II-I-A,
and Appendix B. (NIH
Guidelines April 2002)
Return to Top of the Document
Biosafety Level
A description of the degree of physical
containment to be employed for managing infectious materials in the laboratory environment
where they are being handled or maintained. The purpose of containment is to reduce or
eliminate exposure of laboratory workers, other persons, and the outside environment to
potentially hazardous agents. The levels are designated in ascending order, by degree of
protection provided to personnel, the environment, and the community. The essential elements of the four biosafety
levels defined by the CDC for activities involving infectious microorganisms and
laboratory animals are summarized in Sections III and IV of the Biosafety in
Microbiological and Biomedical Laboratories (BMBL)
4th Edition. (BMBL 4th
Edition)
Return to Top of the Document
|