PHYSICAL HAZARDS Section V: Does the project involve the use of UV Radiation (e.g., lasers, welding)? If check here. If check here. “Yes” “No” If please describe the UV radiation and how individuals will be protected: “Yes”, Does the project involve potential exposure to excessive noise (the need to shout when the person is standing at arms length)? If check here. If check here. “Yes” “No” If please describe the excessive noise and how individuals will be protected: “Yes”, Does the project involve potential exposure to molten material (including smelting and mercury in excess of 50 mL)? If check here. If check here. “Yes” “No” If please describe the molten material, how it is generated and used, and how individuals will be protected: “Yes”, Section VI: BIOLOGICAL MATERIALS Does the project involve the use of the following Biological Materials? If check here and complete the following. If check here and proceed to Section VII. “Yes” “No” Check all that will be used: Human: Blood Body Fluids Unfixed Tissues Fixed Tissues Nonhuman Primate: Blood Body Fluids Unfixed Tissues Fixed Tissues Primary Human Tissues or Cell Culture Continuous Human Tissues or Cell Culture Primary Animal Tissues or Cell Culture Continuous Animal Tissues or Cell Culture Viruses, bacteria, microbes or other biological agents/products ***for recombinant strains, additional details are required in section VII. Administered Source of Biological Material / Agent Description to Animals? Lab Biosafety -Material/Agent? Route of Animal Biosafety Containment (If yes, -Is it recombinant? Administration Containment Level Genus Species/Strain (Yes/No) Level specify which If yes, describe in animal) Section VII. Ad5 (Yes) BSL2 Yes/mice i.v. ABSL2 Human adenovirus C /Type 5 In the space below, please briefly describe how these biological materials/agents will be used:
Section V: PHYSICAL HAZARDS Does the project involve the use of UV Radiation (e.g., lasers, welding)? If “Yes” check here. If “No” check here. If “Yes”, please describe the UV radiation and how individuals will be protected: Does the project involve potential exposure to excessive noise (the need to shout when the person is standing at arms length)? If “Yes” check here. If “No” check here. If “Yes”, please describe the excessive noise and how individuals will be protected: Does the project involve potential exposure to molten material (including smelting and mercury in excess of 50 mL)? If “Yes” check here. If “No” check here. If “Yes”, please describe the molten material, how it is generated and used, and how individuals will be protected: Section VI: BIOLOGICAL MATERIALS Does the project involve the use of the following Biological Materials? If “Yes” check here and complete the following. If “No” check here and proceed to Section VII. Check all that will be used: Human: Blood Body Fluids Unfixed Tissues Fixed Tissues Nonhuman Primate: Blood Body Fluids Unfixed Tissues Fixed Tissues Primary Human Tissues or Cell Culture Continuous Human Tissues or Cell Culture Primary Animal Tissues or Cell Culture Continuous Animal Tissues or Cell Culture Viruses, bacteria, microbes or other biological agents/products ***for recombinant strains, additional details are required in section VII. Source of Biological Material / Agent Description Lab Biosafety Containment Level Administered to Animals? (If yes, specify which animal) Route of Administration Animal Biosafety Containment Level -Material/Agent? -Is it recombinant? (Yes/No) If yes, describe in Section VII. Genus Species/Strain Ad5 (Yes) Human adenovirus C /Type 5 BSL2 Yes/mice i.v. ABSL2 In the space below, please briefly describe how these biological materials/agents will be used:
OHS_Project_Registration.docx