PLANT AGRICULTURE GROWTH FACILITIES
Request Form: Appendix 2 Microorganisms & Pathogens
If your experiment contains Microorganisms & Pathogens you must complete the ‘Request for Growth Facility Space Use’ and
Appendix 2 and also submit a biohazard Permit and an SOP describing your project to Dietmar Scholz
dscholz@uoguelph.ca or
Ron Dutton
rdutton@uoguelph.ca (WORD file is preferred).
Find the Biohazard Permit at
https://www.uoguelph.ca/hr/system/files/BioForm%20Application%202010-amended_1.doc
Please familiarize yourself on the subject of Containment Standards for Facilities Handling Plant Pests which can be referenced
from the CFIA at:
http://www.inspection.gc.ca/english/sci/bio/plaveg/placone.shtml
Provide the type of access you authorize for the User(s) listed in PART A
Name: ____________________________________________
Type of access (check one or both):
Normal working hours evenings/weekends
Name: ____________________________________________
Type of access (check one or both):
Normal working hours evenings/weekends
If there are additional researchers requiring access, please provide their names and access levels here:
Name: ____________________________________________
Type of access (check one or both):
Normal working hours evenings/weekends
Name: ____________________________________________
Type of access (check one or both):
Normal working hours evenings/weekends
Nature of microorganism or pathogen(s): ______________________________________________________________________
Does the compartment need to be locked during normal working hours (check one)? yes or No
Is the trait toxic to humans:? yes or No Does the trait have allergenic properties?
If yes, is it (check one): (ie. Produce skin or lung hypersensitivity)
an acute toxin mutagenic carcinogenic yes or no
Describe any special protective clothing or measures personnel are required to use or follow in handling the microorganism or
pathogen:
Describe any known environmental hazards associated with the microorganism or pathogen:
Will the material be removed from the facility (check one)? yes or no
If yes, describe the procedures to contain, track and dispose of the materials:
Is the material (check one): plant plant parts seed
Loss of containment (potential hazards):
Outline any special measures necessary in the event of loss of containment, inadvertent disposal, or theft of the materials:
I have obtained a Biohazard Permit Application 2010 and agree to abide by the protocols for the safe handling of the
experimental materials. I will ensure that all laboratory workers under my supervision receive training and adhere to the
protocols for the safe handling, containment, storage and disposal of the experimental materials.
_________________________________ ________________________________________ _______________________
Faculty Name Faculty Signature Date
Department Approval:
_________________________________________________________ _____________________________
Signature Coordinator, Growth Facility Date
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