<p> The Catholic University of America Environmental Health & Safety </p><p>Section III. Microbiological Hazard Registration Register one agent per form</p><p>Research Project Title:</p><p>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</p><p>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</p><p>3. Information regarding health surveillance </p><p>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</p><p>4. List all employees who will work with this agent. Employees must undergo appropriate training and be included in appropriate health surveillance programs.</p><p>Names Training Date</p><p>Name of Principal Investigator:</p><p>PI Signature: Section III Microbiological Hazard Registration Page 3 of 3</p><p>Date:</p>