Please Complete and Electronically Submit This Form to

IBC # 00-000

Biological Toxins Form

SECTION 1: GENERAL INFORMATION

Please complete and electronically submit this form to [email protected]. If you have any questions, please contact the IBC administrator at [email protected], or 540-231-1910.

Principal Investigator Name:

Program or Project Title:

SECTION 2: TOXINS

1. Will you be using toxins derived from living organisms, including Select Agent Toxins* Yes No *If your toxin appears on the Select Agent List, you must contact the University Biosafety Officer ([email protected]).

If yes,

a. Complete the information in the below table:

In what form is the Where is Source (name toxin Is an inventory sign- the toxin Storage Stock Concentration(s) of commercial obtained out sheet used for prepared Name of Toxin LD Concentration(s) used (working vendor or (powder, tracking (Y/N)? Where 50 (fume kept in lab stocks) collaborator) liquid, is the tracking log hood, and catalog # from located/kept? BSC)? organism) ?

b. Will you be cloning the genes for any of the above-mentioned toxins? Yes No

If yes, complete the information in the following table:

Source of gene Toxic to Toxic to Toxic to plants Name of Toxin Gene (organism) humans (Y/N)? animals (Y/N)? (Y/N)?

c. Where is the fume hood located (Building/Room)? Note: Powdered toxins must be handled in a fume hood.

Cells/tissues/biohazardous materials 1 of 4 Rev. 1/19/2017 IBC # 00-000

d. Where is the toxin kept when not in use?

e. Will you use needles or sharps in experiments with toxins? Yes No

f. Will the toxin be used in animals? Yes No

If yes,

i. What type of animal(s) will you use?

ii. Route of toxin administration?

Intravenous Intraperitoneal Subcutaneous Intracerebroventricular

Intramuscular Intranasal Other:

g. Describe the major health risks associated with the toxin(s). If toxins will be used in animals, be sure to specify additional risks related to animal handling and husbandry.

h. Describe the primary laboratory hazards associated with the use of the toxin (e.g. accidental inoculation, ingestion).

i. Will you use any of the following devices that have the potential to aerosolize toxin? Check all that apply

Centrifuge If using a centrifuge does it have: Sealed rotors Sealed centrifuge cups

Tissue grinders Sonicators Vortexers

Blenders Shakers Autopsy/necropsy saws

Intranasal/intratracheal inoculation of animals Pressurized vessels (besides autoclaves)

j. What personal protective equipment (PPE) will be used to minimize exposure?

Safety glasses Goggles Faceshield Surgical mask

N95 PAPR Gloves Lab coat

Shoe covers Head cover Other:

k. How will work surfaces be decontaminated after work with toxins?

l. Describe the inactivation and disposal methods of liquid waste contaminated with toxin(s).

m. Describe the inactivation and disposal methods of solid waste contaminated with toxin(s).

2. Select Toxin Information If you are working with any of the toxins listed in the table below, provide a description of the maximum amount of the toxin that is in your possession at any given time. NOTE: If the amount of toxin in your possession is greater than the amount listed in the below table, contact Biosafety Officer Charlotte Waggoner ([email protected]) or Anna Kroner ([email protected]) immediately.

Permissible Toxin Amounts

The following toxins are not regulated if the amount under the control of a principal investigator, treating physician or veterinarian, or commercial manufacturer or distributor does not exceed, at any time, the amounts indicated in the table below.

HHS Toxins [§73.3(d)(3)] Amount Abrin 1000 mg Botulinum neurotoxins 1.0 mg Short, paralytic alpha conotoxins 100 mg Diacetoxyscirpenol (DAS) 10,000 mg Ricin 1000 mg Saxitoxin 500 mg Staphylococcal Enterotoxins (Subtypes A, B, C, D, and E) 100 mg T-2 toxin 10,000 mg Tetrodotoxin 500 mg

3. Will any of the toxins be introduced to immortalized cell lines, tissues, organs, and/or primary cells? Yes No If yes, which toxins?

4. Submit the following additional documents to [email protected] i. MSDS for each toxin ii. Copy of your toxin inventory sheet template

Cells/tissues/biohazardous materials 4 of 4 Rev. 1/19/2017