International Rules: Guidelines for Science and Engineering Fairs 2020–2021, societyforscience.org/ISEF2021 Page 43
Student’s Name(s)
Title of Project
To be completed by the QUALIFIED SCIENTISTDESIGNATED SUPERVISOR in collaboration with the student
researcher(s). All questions are applicable and must be answered; additional page(s) may be attached.
SECTION 1: PROJECT ASSESSMENT
1. Identify potentially hazardous biological agents to be used in this experiment. Include the source, quantity and the
biosafety level risk group of each microorganism.
2. Describe the site of experimentation including the level of biological containment.
3. Describe the procedures that will be used to minimize risk (personal protective equipment, hood type, etc.).
4. What inal biosafety level do you recommend for this project given the risk assessment you conducted?
5. Describe the method of disposal of all cultured materials and other potentially hazardous biological agents.
SECTION 2: TRAINING
1. What training will the student receive for this project?
2. Experience/training of Designated Supervisor as it relates to the student’s area of research (if applicable).
Potentially Hazardous Biological Agents Risk Assessment Form (6A)
Required for research involving microorganisms, rDNA, fresh/frozen tissue (including primary cell lines, human
and other primate established cell lines and tissue cultures), blood, blood products and body luids.
SRC/IACUC/IBC approval required before experimentation.
SECTION 4: CERTIFICATION–To be completed by the LOCAL or AFFILIATED FAIR SRC
The SRC has seen this project’s research plan and supporting documentation and acknowledges the accuracy of the information provided above.
SRC Printed Name Signature
Date of review (mm/dd/yy)
SECTION 3: For ALL CELL LINES, MICROORGANISMS AND TISSUES – To be completed by the QUALIFIED SCIENTIST or
DESIGNATED SUPERVISOR - Check the appropriate box(es) below:
Experimentation on the microorganisms/cell lines/tissues to be used in this study will NOT be conducted at a Regulated Research
Institution, but will be conducted at a (check one) ___BSL1 or ___BSL2 laboratory. [This study has been reviewed by the local SRC and the
procedures have been approved prior to experimentation.]
Experimentation on the microorganisms/cell lines/tissues to be used in this study will be conducted at a Regulated Research Institution and
was approved by the appropriate institutional board prior to experimentation; institutional approval forms are attached.
Origin of cell lines:__________________________________________ Date of IACUC/IBC approval ___________________________
Experimentation on the microorganisms/cell lines/tissues to be used in this study will be conducted at a Regulated Research Institution,
which does not require pre-approval for this type of study. The SRC has seen and approved the research plan and supporting
documentation and acknowledges the accuracy of the responses above.
CERTIFICATION–To be SIGNED by the QUALIFIED SCIENTIST or DESIGNATED SUPERVISOR
The QS/DS has seen this project’s research plan and supporting documentation and acknowledges the accuracy of the information
provided above. This study has been approved as a (check one) BSL1/ BSL2 study, and will be conducted in an appropriate
laboratory.
QS/DS Printed Name Signature
Date of review (mm/dd/yy)
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