Independent Research Risk Assessment

Name(s) Include all collaborating student's names)

Primary contact's email address

Name of supervising faculty member

If applicable, for what course are you performing this independent research?

Briefly describe your project

In what laboratory or field location will you be conducting your research?

When do you propose to start your research?

When do you expect to conclude your research?

Chemical Usage

Name of chemicals you proposed to use that are human carcinogens or reasonably anticipated to be human carcinogens (IARC rating of 1, 2a or 2b)

Name of chemicals you propose to use that are acutely toxic and potentially lethal to humans (oral rat LD 50 of less than 50 mg/kg)

Name of chemicals you propose to use that are strong corrosives (pH less than 2.1 or greater than 11.9)

For each of the chemicals listed previously that are human carcinogens, acutely toxic or strong corrsives, calculate the maximum quantity that can be used in the laboratory in which you are working. This is only possible if the MSDS provided TLV or PEL values.

Name of chemicals you propose to use that are very flammable (HMIS flammability ratings of 3 or 4 or flashpoint below 100 degrees Fahrenheit or 38 degrees Celsius)

Name of chemicals you propose to use that are water-reactive or pose severe explosion hazards (HMIS rating of 3 or 4 or shock or heat might cause explosion)

Names of chemicals you propose to use that have hazardous decompositions products that are either human carcinogens or acutely toxic

Names of chemicals you propose to use that are radioactive

Names of chemicals you propose to use that are controlled substances (DEA controlled substances)

Biohazards

After consulting the Biosafety plan's Table A, list the "organisms of concern" to which you might be exposed during your research

Considering the information found in the Table A of the Biosafety plan, what biosafety level procedures will you need to use (BSL 1, BSL 2, ABSL1 or ABSL2)

 The research you propose will include the use of human blood or body fluids.

Describe how you will disinfect equipment, surfaces and glassware that have been contaminated by biologically acitve material. (See Biosafety, Appendix III)

Describe how you will dispose of any living or dead organisms or biologically active material that you will use

 Living organisms that you propose to use are native species to this area of Minnesota
 Field work you propose to do is performed at a location more than a 15 minute walk from the Science Centers

Field Work

Risk Rating

 My work is considered "low risk" after consulting Section 9 of the Chemical Hygiene Plan
 My work is considered "medium risk" after consulting Section 9 of the Chemical Hygiene Plan
 My work is considered "high risk" after consulting Section 9 of the Chemical Hygiene Plan