Biological Laboratory Decommissioning

IBC #:*

List ALL active IBC numbers, separated by comma.

Biosafety Level (BSL):*

Principal Investigator (PI):*

Email:*

Phone:*

Department:*

Form completed by:*

Email:*

Lab Bldg./Rm. Number(s):*

Decommissioning Form Submission Date:*

Disposition of Biological Materials:

Do you currently have any biological materials?*

Includes pathogens, human/animal specimens, toxins, soil, and water samples containing potential pathogens.

Do you currently have any samples containing biological materials?*

(e.g.: rodent specimen collected from transgenic animal or animal treated with r/s nucleic acids, or pathogens.)

Do you plan to retain any of the biological materials listed on the protocol?*

Please describe how you will dispose of these biomaterials prior to decommissioning the laboratory:*

(e.g.: disposal as BSL2 biohazardous waste is picked up by EHS; chemical neutralization of materials per approved IBC SOP (liquid waste).

Complete the appropriate section below:*

I plan to submit a new BUA for their possession.

I plan to transfer the biological materials.

The biological materials will be transferred to:*

(other university, state, etc. List locations for transfer following appropriate shipping SOPs and MTAs.)

PI Name:*

List the name of the PI the biological materials will be transferred to.

Biomaterial(s) to be transferred and location of transfer (Building, Room Number):*

IBC #:*

Storage:*

Location and temperature of transferred materials.

Equipment Decontamination

Have the following items been decontaminated?*

Biosafety Cabinets

Freezers

Centrifuges

Incubators

Refrigerator/Cold Cabinets

Other

Equipment as applicable

List other decontaminated equipment:*

Will any of the selected or listed equipment be transported off campus?*

Yes

Will any of the selected equipment be donated to another UA lab?*

Yes

List PI and lab receiving donated equipment:*

Have all pieces of equipment had decommissioning tags assigned by EHS?*

Yes

This field is for validation purposes and should be left unchanged.

Biological Laboratory Decommissioning

Biological Laboratory Decommissioning Form

Disposition of Biological Materials:

Equipment Decontamination