Biological Material Survey

IUPUI Biological Material Survey - 2004

In order to maintain a database of all biological material at IUPUI, it is necessary that every Principal Investigator complete the following form. Please complete Part 1 of the Biological Material Survey Form, even if you do not possess or utilize biological materials in your research areas. Those Principal Investigators that do possess and/or use biological materials are required to complete Part 2.
PI Last Name:	^*	First Name:	^*
Email:	^*	Office Phone:	^*
Department:	^*	Division/Section:
Building:	^*	^* is required field
PLEASE CHECK HERE IF YOU DO NOT USE OR STORE ANY FORM OR TYPE OF BIOLOGICAL MATERIAL IN YOUR RESEARCH AREA(S)

Please complete Part 2 of the Biological Material Survey Form:
Q1. Does your research involve the use of a Biosafety Cabinet? No Yes If Yes, please give the location(s) (Bldg/Room)

Q2. Does your lab use an autoclave to treat biological waste prior to disposal? No Yes If Yes, please give the location(s) (Bldg/Room)

Q3. Does your lab possess or use any of these Agents?
Bacterial	No Yes	If Yes, please list
Fungal	No Yes	If Yes, please list
Rickettsial or Parasitic	No Yes	If Yes, please list
Viral	No Yes	If Yes, please list
Prions	No Yes	If Yes, please list
Biological Toxins	No Yes	If Yes, please list

Q4. Does your research utilize any of the following viral vectors? Check all that apply.
Adenovirus Human Retrovirus Lentivirus Murine Retrovirus Baculovirus Spumavirus

Q5. Does your research involve any use of the following? Check all that apply.
Unfixed Human Tissues/Cells Human Blood or other Body Fluid Continuous Cell Lines/Cultures of Human Origin Non-Human Primate Cells/Materials/Fluids

Please list all IUPUI lab personnel (First and Last Name) in the following text fields:
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.

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This document was last modified April 2005
Copyright © 2003-2004 The Trustees of Indiana University