Forms

Several forms have been developed in order to assist the Principal Investigator with the required submissions and filings required by the federal regulatory agencies that have jurisdiction over research activities. The following instructions are provided to assist you in completing these forms.

These forms are provided in Microsoft Word. Except where otherwise noted, you may fill out the gray text areas and checkboxes in Microsoft Word. Then you will need to print the forms, fill out any fields that require manual input (e.g., signature), and submit them. Completed forms should be provided via fax to: 212-241-6695 or by scanned attachment and emailed to biosafety.ibc@mssm.edu

Form IBC-1 Institutional Biosafety Committee Risk Assessment Form

You are required to report any and all recombinant DNA/RNA/Synthetic Molecule activities to the Institutional Biosafety Committee in compliance with Section III of the National Institutes of Health (NIH) Guidelines. This applies whether the research is funded by the NIH, or by another funding source, since the Icahn School of Medicine at Mount Sinai receives NIH funding

Form BSO-1 Report of Laboratory Accident

If you have had an accident / exposure, you are required to report the incident if it involves HUMAN blood / body fluids. The purpose of the report is to provide documentation that the illness that may develop as a consequence of the incident is work-related. 

Form BSO-2 Certificate of Decontamination

OSHA and EPA regulations require that any analytical equipment freezers, refrigerators, incubators that were used with infectious agents or Human blood or body fluids receive decontamination prior to disposal or return to manufacturer or a service company. This form is used to record the date and method of decontamination and provide tracking documentation in the event of an inquiry by one of these agencies.

Form BSO-3 Laboratory Self-Inspection Form Biohazard Precautions

This form is used to self-appraise your compliance activities in the laboratory or to self-report Biosafety Levels to the Biosafety Officer when required by a Funding Agency. Based on the CDC's Biosafety in Microbiological and Biomedical Laboratories (BMBL) 4th Edition.