Bioplex 100 Luminex Machine

Date: ______Year: August 2017 - 31st July 2018 Principal Investigator: ______Phone Number: ______

E-mail: ______

Staff member using Flow Cytometry Facility: ______Phone Number: ______Lab Number: ______E-mail: ______

Are you an existing user having been trained by 3I’s Flow core staff? (Yes/No)

All new users must be formally trained on the machines by 3I’s Flow core staff.

Please answer all of the questions below, print, sign and date and return, to the Flow Cytometry Facility, Room B4/44

Project Title:

Cell types for analysis: ______Species: ______Pathogen or Cells from potentially infectious source? Yes ______No ______Pathogen

If Yes indicate Hazard Class of organism: Class I _____ Class II_____ Class III___

Fixed cells from prior infectious source? Yes ______No ______Please indicate fixative used: ______Note. It is the P.I.’s responsibility to insure that the fixation used is suitable to render the samples non-infectious. For human samples, what is the source of cells (eg. volunteers, patients, blood bank, etc.) and are patients tested for HIV, Hepatitis, HTLV, EBV, other pathogens? ______

For cell lines, were they transformed by, or carry, any known viral pathogens (e.g. HIV, EBV, other)? ______IF NOT TESTED, PLEASE INDICATE: ______

Have copies of COSHH forms been submitted to the facility? Yes ____ No ____

Please give relevant COSHH form number ______

1 Analysis of genetically manipulated cells

Are the cells to be analysed genetically engineered or manipulated? Yes ______No______

If yes, is a gene therapy virus, eg. adenovirus, retrovirus, lentivirus, herpesvirus, etc., employed? Please indicate and specify:- Viral vector: ______(e.g., LentiMax, or other) Is a helper virus used also? ______If so, which? ______Nature of insert(s) (oncogenes?): ______Replication incompetent (specify):______Capacity of virus to infect human cells: ______Are transduced cells passaged at least 3 times prior to analysis? Yes ______No ______Are cells transfected with plasmids? _____ Nature of inserts? ______

Have copies of GMO approval documents been submitted to the facility? Yes ____ No ____

Please give relevant GMO form number ______

Signature of P.I. ______

Date: ______

Signature of staff member: ______

Date: ______

Note. Safe use of the Flow Cytometry Facility relies upon co-operation between the staff and investigators who use the facility. As cell types and/or bio-hazard information change, prior to the next annual survey, this form must be up- dated. BILLING INFORMATION

Before completing this section please refer to the 3I’s Flow Cytometry Facility charges document on our web pages.

Gold and Silver Bench Fee

2 If you are based in the GBRC and pay a silver or gold bench fee use of the Luminex is free of charge.

Principle Investigator College/Institute Cost Centre Project Code NB email to Alison Wallace Head of Research Administration

` Non 3I Users

There is a charge of £100 per Luminex plate run

Principle Investigator College/Institute Cost Centre Project Code

User Category 6 –External commercial user

Please give the address to which invoices should be sent: