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Record Keeping for Labs Using Federally Regulated Quantities of Select Agents
The following forms are available as Word documents:
Select Agent Federal Registration Changes and Renewal Form
The University’s Select Agent Federal Registration needs to be renewed every three years. Submit this form to Environmental Health and Safety (DEHS) to request registration renewal or to make any changes to your existing registration. Changes that need to be reported include; change in location of select agent, change in authorized users, significant change in select agent protocol, or change in research objective.
Record of Transfer to Registered Lab Within the University or Destruction of a Select Agent
Use this form to advise DEHS of a change in your select agent inventory. Transfer within the University is only allowed between registered laboratories. Destruction of select agents requires prior approval from CDC and DEHS.
Select Agent Inventory Record of Changes to Long-term Storage
Use this form, or a form customized by your laboratory, to keep a continuous inventory record. Submit to DEHS on a quarterly basis.
Select Agent Use or Storage Area Access Log – Authorized Individuals
Use this form, or one customized by your laboratory, to maintain a record of select agent access by authorized individuals. A DEHS auditor will review these records every six months.
Select Agent Use or Storage Area Access Log – Unauthorized Individuals
Use this form, or one customized by your laboratory, to maintain a record of select agent access by unauthorized individuals. A DEHS auditor will review these records every six months.
Approved Access Individual Signature Log
Use this log to keep a signature record for authorized individuals as a means to verify select agent access. Submit to DEHS whenever a new individual is granted authorized access.
Select Agent Research Lab Record of Training
Customize this form to reflect any training involving select agents. File one copy with your laboratory’s training records and submit one copy to DEHS.
Submit all forms by mail or in person (do not send electronically) to:
Biosafety Officer
Environmental Health and Safety
W-140 Boynton Health Service
For questions, please call 612-624-5479