<p>Bioplex 100 Luminex Machine</p><p>Date: ______Year: August 2017 - 31st July 2018 Principal Investigator: ______Phone Number: ______</p><p>E-mail: ______</p><p>Staff member using Flow Cytometry Facility: ______Phone Number: ______Lab Number: ______E-mail: ______</p><p>Are you an existing user having been trained by 3I’s Flow core staff? (Yes/No)</p><p>All new users must be formally trained on the machines by 3I’s Flow core staff.</p><p>Please answer all of the questions below, print, sign and date and return, to the Flow Cytometry Facility, Room B4/44</p><p>Project Title:</p><p>Cell types for analysis: ______Species: ______Pathogen or Cells from potentially infectious source? Yes ______No ______Pathogen </p><p>If Yes indicate Hazard Class of organism: Class I _____ Class II_____ Class III___</p><p>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? ______</p><p>For cell lines, were they transformed by, or carry, any known viral pathogens (e.g. HIV, EBV, other)? ______IF NOT TESTED, PLEASE INDICATE: ______</p><p>Have copies of COSHH forms been submitted to the facility? Yes ____ No ____</p><p>Please give relevant COSHH form number ______</p><p>1 Analysis of genetically manipulated cells</p><p>Are the cells to be analysed genetically engineered or manipulated? Yes ______No______</p><p>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? ______</p><p>Have copies of GMO approval documents been submitted to the facility? Yes ____ No ____</p><p>Please give relevant GMO form number ______</p><p>Signature of P.I. ______</p><p>Date: ______</p><p>Signature of staff member: ______</p><p>Date: ______</p><p>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</p><p>Before completing this section please refer to the 3I’s Flow Cytometry Facility charges document on our web pages.</p><p>Gold and Silver Bench Fee</p><p>2 If you are based in the GBRC and pay a silver or gold bench fee use of the Luminex is free of charge.</p><p>Principle Investigator College/Institute Cost Centre Project Code NB email to Alison Wallace Head of Research Administration</p><p>` Non 3I Users</p><p>There is a charge of £100 per Luminex plate run</p><p>Principle Investigator College/Institute Cost Centre Project Code </p><p>User Category 6 –External commercial user</p><p>Please give the address to which invoices should be sent:</p><p>3</p>