Part II: Continue only if you answered to any of the questions in Part I. ‘yes’ We need to collect a few more details related to your occupational exposures related to pathogens and animals. PATHOGENS Exposures: NIH Risk Group Classifications Factors that determine the specific risk group classification for infectious agents include the following: pathogenicity of the organism mode of transmission and host range availability of effective preventive measures (for example, vaccines) availability of effective treatments (for example, antibiotics) NIH Basis for the Classification of Biohazardous Agents by Risk Group (RG) Risk Group 1 Agents that are not associated with disease in healthy adult humans. (RG1) Risk 2 Agents that are associated with human disease which is rarely serious and for which preventive or (RG2) therapeutic interventions are available. often Risk Group 3 Agents that are associated with serious or lethal human disease for which preventive or therapeutic (RG3) interventions (high individual risk but low community risk). may be available Risk Group 4 Agents that are likely to serious or lethal human disease for which preventive or therapeutic (RG4) interventions are available (high individual risk and high community risk). not usually You may also refer to Appendix B of the for a current NIH Guidelines for Research Involving Recombinant DNA Molecules list of microorganisms in each risk group. This resource can be found on: Please answer the following: I am not listed on a research protocol but I work in an area Risk Group 3 agents are directly handled, or where animals potentially infected with RG 3 agents are located. Yes __No __ I am not listed on a research protocol but I work in an area where Risk Group 2 agents are directly handled, or where animals potentially infected with RG2 agents are located. Yes __No __ Please list any Institutional Biosafety (IBC) or Institutional Animal Care and Usage (IACUC) protocols in which you participate: Or, check the following: I do not participate in any IBC or IACUC protocols _________________. IBC/IACUC Principal Investigator Department Protocol # I am only handling diagnostic laboratory samples which are potentially infected with Risk Group 2 and/or 3 agents. Yes __No __
Part II: Continue only if you answered ‘yes’ to any of the questions in Part I. We need to collect a few more details related to your occupational exposures related to pathogens and animals. PATHOGENS Exposures: NIH Risk Group Classifications Factors that determine the specific risk group classification for infectious agents include the following: pathogenicity of the organism mode of transmission and host range availability of effective preventive measures (for example, vaccines) availability of effective treatments (for example, antibiotics) NIH Basis for the Classification of Biohazardous Agents by Risk Group (RG) Risk Group 1 (RG1) Agents that are not associated with disease in healthy adult humans. Risk 2 (RG2) Agents that are associated with human disease which is rarely serious and for which preventive or therapeutic interventions are often available. Risk Group 3 (RG3) Agents that are associated with serious or lethal human disease for which preventive or therapeutic interventions may be available (high individual risk but low community risk). Risk Group 4 (RG4) Agents that are likely to serious or lethal human disease for which preventive or therapeutic interventions are not usually available (high individual risk and high community risk). You may also refer to Appendix B of the NIH Guidelines for Research Involving Recombinant DNA Molecules for a current list of microorganisms in each risk group. This resource can be found on: Please answer the following: I am not listed on a research protocol but I work in an area Risk Group 3 agents are directly handled, or where animals potentially infected with RG 3 agents are located. Yes __No __ I am not listed on a research protocol but I work in an area where Risk Group 2 agents are directly handled, or where animals potentially infected with RG2 agents are located. Yes __No __ Please list any Institutional Biosafety (IBC) or Institutional Animal Care and Usage (IACUC) protocols in which you participate: Or, check the following: I do not participate in any IBC or IACUC protocols _________________. IBC/IACUC Protocol # Principal Investigator Department I am only handling diagnostic laboratory samples which are potentially infected with Risk Group 2 and/or 3 agents. Yes __No __
OHP%20Risk-Enrollment%20Form.docx