A.Specify Material and Source

SECTION C
BIO SAFETY INFORMATION

C1.Biological Material/Animal Products for use in animals (e.g. human cell lines, transplantable tumors, tissues):

a.Specify material and source:

C2.Recombinant DNA Technology and Transgenic and Knockout Rodent/Animal Use (For further assistance with completing this section contactMariel Jais ):

a.Are transgenic or knockout rodents to be used commercially available?

Yes: go to question C4 / No, answer question C3

C3.Who is producing the transgenic rodents?

C4.Does the project involve the use of recombinant DNA? If yes, please provide your GWU IBC registration number and approval date or contact the above-mentioned Biosafety Team personnel for assistance with completion of your recombinant DNA registration.

C5.Will you be using controlled substances in this project?

_____Yes_____No

If yes-

DC Controlled substance license #:______

Licensee:

License address:

DEA controlled substance license #:______

Licensee:

License address:

HAZARDOUS MATERIALS
If you are using a hazardous agent in conjunction with your project, please contact Biosafety Upon request of the IACUC, the Biosafety reviews Animal Use Forms for compliance with applicable health and safety regulations as they pertain to radiation, chemical and biological safety. The Biosafety will provide training and information to assist the PI in meeting his/her responsibility.

C6.Fill out the appropriate section below. Please reproduce each section as many times as needed.

Toxic Hazards
Projects involving the use of hazardous chemicals and infectious agents are guided by internal GWU policies in accordance with local, state and federal requirements and guidelines. Projects using these materials may not need prior approval by the Biosafety; however, non-compliance can result in interruption or termination of the project. It is the responsibility of the PI to assure compliance.
Chemical Name
Concentration (Dosage)
Route of Administration
Duration of Exposure
How long animal is maintained
Is chemical a known or suspected carcinogen
Biological Hazards
Projects involving recombinant DNA or transgenic animals require prior Institutional Biosafety Committee approval.
Infectious agent
Concentration (Dosage)
Route of Administration
Duration of Exposure
How long animal is maintained
Is the agent infectious to humans or animals
IBC Approval Date (if applicable)
Radioactive Hazards
Projects involving the use of radioactive materials require prior approval by the Radiation Safety Committee.
Radioisotope
Amount Administered (mCi)
Route of Administration
Duration of Exposure
How long animal is maintained
Radiation Safety Committee Approval Date
Gas Anesthetic
Agent(s)
Equipment used
Scavenging system used

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The George Washington University

Revised June 6, 2012