Biosafety form

General Information

(fill out general information details only if user ID and project ID are unknown)

Title

Name *

First

Middle

Last

Organisation *

Department *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

1. Sample

Sample description *

Protein acronym *

Source origin *

Risk Class *

http://www.vib.be/en/training/Documents/Biosafety%20in%20the%20laboratory.pdf

2. Is the sample recombinant?

If yes please explain

Expression host

Risk Class

http://www.vib.be/en/training/Documents/Biosafety%20in%20the%20laboratory.pdf

3. Is the sample an active virus? *

4. Is the sample a toxin? *

5. Is the sample a prion protein? *

6. Is the sample a virulence factor? *

7. Does the sample present any risk to human health and or environment? *

If yes, please explain:

8. Are you planning to work with hazardous ligands (not including uranyl for NS)? *

If yes, please explain:

9. Is there any danger associated with the storage, use of equipment and/or disposal of the sample? *

If yes, please explain:

Single Line Text

Checkboxes *

I certify that all details if the sample form are complete and correct

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GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Please fill out one form per biological component

General Information

1. Sample

2. Is the sample recombinant?