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Biohazard Form
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For MIT, Is this material approved under your PI’s Biological Research Registration (BRR)? (by MIT CAB/ESCRO) If yes what is the BRR number? If not please contact your Biosafety officer at
BSP@mit.edu
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For outside MIT, Do you have a current Institutional Biosafety Committee approval for this project? If yes, please have your Institutional Biosafety Officer email us at
flowcore@mit.edu
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Name
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Email
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MIT ID #
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Phone number
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PI/Department
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Cell Type/Line/Virus/Bacteria/Fungi/Parasite/Rickettsia/Prion (…) (i.e. 293, mouse spleen, Staphylococcus aureus, Candida albicans, Plasmodium sp., Influenza/Prion/Rickettsia rickettsia)
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Biohazard Level (i.e. BL-1, BL-2 Etc .) At MIT all human cells and human cell lines are BL2.
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Any known Infectious/Pathogenic Agents?
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Yes
No
If Yes, please list agents. If No, write No.
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Has the Infectious/Pathogenic agent been deactivated?
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Yes
No
If Yes, what was the inactivation method? If No, write No.
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Are samples primary human cells
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Yes
No
If primary cells, were the donors screened for HIV, Hepatitis B, Hepatitis C or other bloodborne pathogens?
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Yes
No
Are samples established human cells
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Yes
No
If established cells, were the cell lines screened for bloodborne pathogens?
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Yes
No
Have the cells been fixed?
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Yes
No
If Yes, what was the fixative? If No, write No.
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Were the cells transformed using a virus (EBV, HTLV-1, Herpes, Etc?)
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Yes
No
If Yes, list virus. If No, write No.
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Were the cells genetically engineered or used with rDNA?
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Yes
No
If Yes, how were the cells engineered? If No, write No.
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Was a virus or viral vector system used?
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Yes
No
If Yes, list the virus or viral vector (Adenovirus, retrovirus, lentivirus, herpes virus Etc.) If No, write No.
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What viral vector generation, (i.e. 2nd, 3rd)?
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What are the safety features (i.e. self-inactivating)?
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What is the pseudotype and host range?
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Is your viral vector replication competent or incompetent?
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For 2nd generation lentiviral vectors, how do you test for replication competent lentivirus?
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How many times have the cells been washed?
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Please list all fluorophores being used in your experiment (i.e. GFP, PE,PI)
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Number of controls
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Number of samples
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In lay terms, please explain the application of your experiment (i.e. New vector system, looking for % GFP positive, measuring Apoptosis using Annexin V + PI.)
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