Spills and Exposures Procedures (R-DNA)

Spills and Exposures Procedures Report

Spill or Exposure Event Report:

If a spill or exposure to Recombinant DNA or Synthetic Nucleic Acid Molecules occurs in your laboratory, please complete the following information and give to the Biosafety Officer. This will serve as a record of the event and be used for NIH PBBP reporting, if necessary.

Date of Event: *

Principal Investigator: *

IBC Registration #: *

Building/Room #: *

Location with room (bench, biosafety cabinet, centrifuge, etc.): *

Type of Event (spill, puncture wound, etc.): *

Names of lab personnel involved/exposed: *

Site of exposure (eye, mouth, etc; if applicable):

Agent (Recombinant Lentivirus, recombinant adenovirus, etc):

Gene encoded by vector:

Known Oncogene: *

Yes

Containment level (BSL2, BSL2 enhanced, etc) & Amount exposed (pfu, µl, etc: if known):

Narrative of post exposure/spill response (please describe disinfectant agents, washing of exposed sites, PPE worn during clean up, etc.): *

Did the affected individuals needs medical treatment and, if so, where were they treated?: *

Yes, and where were they treated?Yes, and where were they treated?

Date submitted to Biosafety Officer: *

If you are human, leave this field blank.

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