Biological Incident Report

This report, when submitted, provides the University Safety and Assurances Department, Biological Safety Program, and the Institutional Biosafety Committee with information to ensure that proper actions have been taken, including appropriate medical care, and helps the University meet National Institutes of Health reporting requirements.

If you have an approved biosafety protocol, please navigate to IManager and submit the xForm in your protocol. Just log in, select the protocol number, and when viewing that protocol, select “Start xForm in the left column” and select the Biosafety Initial Report of Biological Exposure or Release Event and Near Misses xForm to complete.

Principal Investigator Name(Required)

First Last

Principal Investigator Phone(Required)

Contact Name(Required)

First Last

Contact Phone(Required)

Contact Email(Required)

Department

Location of Event

Nature of Event (explain what happened and how it occurred)

Date of Event (MM/DD/YYYY)

Time of Event

Names of individuals involved

Organism/ Toxin Involved

Biosafety Level

Does this exposure or release event involve recombinant biological materials?

Recombinant

Non-Recombinant

Unsure

If recombinant, what genes were introduced into the organism? (Include toxins, antibiotic-resistant genes, or changes that may affect risks and treatment)

Provide a brief description of the exposure/ release event.

Provide a brief description of how you and/ or your personnel responded to the event.