Check all that Latency potential apply Other: Specify Host Target Cells In vivo Type of Gene Ex vivo Transfer Biological Safety Biological Level Risk BSL 1 Assessment BSL 2 Indicate the BSL 2+ and Safety highest BSL Precautions applied in the experiment Location(s) and PPE Description of Work Building name / Patient Isolation PPE (Surgery, treatment, Room number Check all that apply prep, patient care, other) single glove double glove surgical mask Standard respirators* Contact goggles/safety glasses 1. Droplet Face shield Aerosol lab coat disposable lab coat/gown Other: single glove double glove surgical mask Standard respirators* Contact goggles/safety glasses 2. Droplet Face shield Aerosol lab coat disposable lab coat/gown Other: * The use of respirators requires medical evaluation and fit test prior to use. Will there be any N/A Specific additional room ventilation Location specifications room signage Features for work Other: locations
Check all that apply Latency potential Other: Specify Host Target Cells Type of Gene Transfer In vivo Ex vivo Biological Risk Assessment and Safety Precautions Biological Safety Level Indicate the highest BSL applied in the experiment BSL 1 BSL 2 BSL 2+ Location(s) and PPE Building name / Room number Description of Work (Surgery, treatment, prep, patient care, other) Patient Isolation PPE Check all that apply 1. Standard Contact Droplet Aerosol single glove double glove surgical mask respirators* goggles/safety glasses Face shield lab coat disposable lab coat/gown Other: 2. Standard Contact Droplet Aerosol single glove double glove surgical mask respirators* goggles/safety glasses Face shield lab coat disposable lab coat/gown Other: * The use of respirators requires medical evaluation and fit test prior to use. Specific Location Features Will there be any additional specifications for work locations N/A room ventilation room signage Other:
Form%20Q-1.docx