ࡱ> ~}) =bjbj 6Jdddd9 8$upy !+"Tttttttt$xzt]"W "y ""tJu$$$"Ft$"t$$FlKt0"FoTt`u0uOp{ #{Kt{Kth""$"""""tt$"""u""""{""""""""" : UA Little Rock Institutional Biosafety Committee Application for Initial Screening of Research Projects involving Biohazardous Materials Principal Investigator(s)  FORMTEXT      _____________________ Department / Division:  FORMTEXT      ____________________ Degree:  FORMTEXT      _______ Title/Position:  FORMTEXT      ____________________ Co-Investigator(s):  FORMTEXT      _________________________ Faculty Sponsor (If Applicable):  FORMTEXT      _________________ Office Phone:  FORMTEXT      ___ Lab Phone:  FORMTEXT      _____ Building:  FORMTEXT      ___________ Lab Room #:  FORMTEXT      ________ Email:  FORMTEXT      ___________________________ FAX:  FORMTEXT      ______________ Emergency phone number:  FORMTEXT      ___________________ Contact person (if other than principal investigator):  FORMTEXT      _____________________ Title/Position:  FORMTEXT      _________________________________ Phone#:  FORMTEXT      _____ List Any Current or Previously Approved IBC Protocol#  FORMTEXT      _____ End Date:  FORMTEXT      _____ Protocol#  FORMTEXT      _____ End Date:  FORMTEXT      _____ Please answer the questions below. I. Does your research involve the use of human/primate blood, tissues, cell lines, experimental animals or any hazardous biological agents? ............................................................................................YES  FORMCHECKBOX  NO  FORMCHECKBOX  Biohazardous agents include infectious/pathogenic agents classified as Class 2, 3, or 4 bacterial, fungal, parasitic, rickettsial, or chlamydial agents as defined by the NIH or other agents that have the potential for causing disease in healthy animals or plants or biological toxins, including metabolites of living organisms and materials rendered toxic by the metabolic activities of microorganisms (living or dead). II. Does your research involve the use of Recombinant DNA? ..YES  FORMCHECKBOX  NO  FORMCHECKBOX  Recombinant DNA is defined as 1) molecules which are constructed outside living cells by joining natural or synthetic DNA molecules that can replicate in a living cell, or 2) molecules that result from the replication of those described in (1) above. By entering my name below, I certify that the information I have provided is complete and correct, to the best of my knowledge. I am familiar with and agree to abide by the provisions of the current NIH/CDC Guidelines and other specific granting agency instructions pertaining to research involving hazardous biological agents and/or recombinant DNA.  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If you answered NO to both questions I and II, you will not be required to complete any additional forms. However, you must notify IBC and submit IBC protocol if your research plans change such that it requires the use of biohazardous materials. Any research that requires the use of biohazardous materials must be approved by the UA Little Rock IBC. 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