Section III Microbiological Hazard Registration

The Catholic University of America Environmental Health & Safety

Section III. Microbiological Hazard Registration Register one agent per form

Research Project Title:

1. Agent Information Agent (genus, List drug resistance of Biosafety Largest Animal species, and/or strain, if applicable Level Volume Used Use strain) □ Yes □ No

2. Please provide an overview (250 words or less) of the following:  Specific information about how the biological agent will be used  Procedures that involve the agent  Concentrations and amounts that will be used in each technique  Infectious doses for humans and/or animals, if known Section III Microbiological Hazard Registration Page 2 of 3

3. Information regarding health surveillance

Immunizations Conditions that may Pathogenic potential Route of transmission required or preclude working to recommended with this agent □ Inhalation □ Humans □ Yes: □ Pregnancy □ Ingestion □ Animals □ Immunosuppression □ Inoculation □ Cell lines □ Other: □ Mucous membrane □ Transforming agent □ No

4. List all employees who will work with this agent. Employees must undergo appropriate training and be included in appropriate health surveillance programs.

Names Training Date

Name of Principal Investigator:

PI Signature: Section III Microbiological Hazard Registration Page 3 of 3