CCF New User Registration

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Cell Culture
New User Registration

This form is for all users of the Cell Culture Facility.
Items marked with a * must be completed.

First Name*

Middle Initial

Last Name*

Department*

Building*

Office Phone*

Home Phone

Are you a COM Faculty or Staff Member?
Yes No

Principal Investigator*

Room number*

Lab Phone

E-mail address*

Project Title*

Describe the project*

Is this research funded by a grant?* Yes No If yes, funding number:

Cell Type*

Do the samples contain any hazardous or infectious agents* Yes No
If yes, list them.

List any known human pathogen

Does your work require you to receive immunizations or test for agents handled or potentially present in the laboratory (e.g., hepatitis B vaccine or TB skin testing)* Yes No
If yes, contact Environmental Health and Safety at 850-644-5374 or 850-644-8916.

Please check the highest biosafety level you believe to be appropriate for your work*
Biosafety Level 1 Biosafety Level 2 Biosafety Level 3

Please specify any additional info to help determine the safety level of project

Have you attended FSU Biosafety Level II Training?* Yes No
If no, you must attend a training session provided by FSU Environmental Health and Safety. Sign up on their web site.

Has this project been approved by the Biosafety Officer and Chair?* Yes No
If yes, submit one copy of the approval memo to Ruth Didier College of Medicine Building MRB Room3314 or by fax to (850) 644.5781.

Does this project involve recombinant DNA?* Yes No

If no, you may stop at this point and press the submit at the bottom of the page.

If yes, continue here.

Fill out the Recombinant DNA Registration Update Form and submit one copy to Ruth Didier at the College of Medicine Building MRB Room 3314 or by fax to (850) 644.5781 and one copy to Environmental Health and Safety.

Please indicate whether you believe your work is “exempt” according to the NIH Guidelines.
Yes, I believe this work is EXEMPT according to the NIH Guidelines.
No, I believe this work is NOT EXEMPT according to the NIH Guidelines.

Recombinant DNA Risk Assessment

Is the inserted gene encode a known toxin or a relatively uncharacterized toxin? Yes No

Does the modification have the potential to alter the host range or cell tropism of the virus? Yes No

Does the modification have the potential to increase the replication capacity of the virus? Yes No

Does the inserted gene encode a known oncogene? Yes No

Does the inserted gene have the potential for altering the cell cycle? Yes No

Does the viral DNA integrate into the host genome? Yes No

What is the probability of generating replication-competent viruses?

Is the inserted gene encode a known toxin of a relatively uncharacterized toxin? Yes No

Confirmation Code:* Enter the code exactly as you see it.

Cell Culture New User Registration

Recombinant DNA Risk Assessment

Cell Culture
New User Registration