ࡱ> `b_U  bjbjnn caa^. . 8<2%("6>t $$$$$$$$&(f$"6$ $fffF$f$ff:","{)ivG" $$0%Q"R0)P0)"0)"f$$^%0). B p:  MEMORANDUM OF UNDERSTANDING AND AGREEMENT (MUA) CONCERNING PATHOGENS (Check one box and IBC number) This is a new MUA [ ]. This is a revision MUA [ ] ; IBC Registration No.: Principle Investigator (PI) information (fill-in boxes): Full name:[ ]Department[ ]Office location:[ ]Campus address:[ ]Campus phone number:[ ]Email address:[ ]Home address:[ ]Home phone number:[ ] IBC Actions (Reviews, certifications, etc.) and dates: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Certification statement: I. The information below is accurate and complete. I am familiar with and agree to abide by the relevant provisions of the current BIOSAFETY IN MICROBIOLOGICAL AND BIOMEDICAL LABORATORIES (BMBL) 5TH EDITION [ HYPERLINK "http://www.cdc.gov/biosafety/publications/bmbl5/index.htm" http://www.cdc.gov/biosafety/publications/bmbl5/index.htm, as of December 2009] and other specific instructions from CDC/NIH and the IBC pertaining to this project. II. I certify that the Institutional Biosafety Committee of the ɫ has reviewed this MUA and the project and has found the described research and procedures compliant with the current CDC/NIH Guidelines and that the IBC. III. I certify that I will be responsible to train the researcher(s) with the containment procedures described by the CDC/NIH Guidelines. I will monitor the activities of researchers to ensure that their activities are compliant with the Guidelines. Signature: ___________________________________ Date: __________________ IV. Locations: Give the names of the buildings and room numbers of all facilities that will be used in the described activates. Building(s)Room number(s) V: Personnel: Give the full name, title, contact information of all personnel engaged in the described experimentation. Full nameTitleContact information VI. Description of the experiments: Give a brief (~one page) description of the project and the experiments in non-technical language. This is to help the IBC members and other non-specialists understand the nature of the project and its significance. VII. Containment levels: For each experiment (1, 2, 3 . . .) described above: indicate the biosafety level as described in Section IV of Biosafety in Microbiological and Biomedical Laboratories of the CDC ( HYPERLINK "http://www.cdc.gov/biosafety/publications/bmbl5/index.htm" http://www.cdc.gov/biosafety/publications/bmbl5/index.htm) [BSL-1(Biosafety Level 1), BSL- 2, etc.)], (b) cite relevant sections of the CDC Guidelines (c) briefly describe the facilities and procedures which will be used to attain biosafety levels. Describe so that IBC members and non-specialists understand. Give sufficient information to justify the choices of procedures and biosafety levels. VIII. Facilities: Describe the facilities to be used and explain how they meet the CDC Guidelines. VIII. Personnel Training: Describe how the PI will train the personnel to make them familiar with the CDC Guidelines and the procedures to be followed in case of accident.     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