Flow Cytometry Shared Resource
RC1 south, room 4215, 303-724-3145
Sort Sample Submission Biosafety Questionnaire
1. Have you submitted a project biosafety questionnaire? Yes ☐/ No ☐
2. Information about your sample
a. Is sample of human origin? Yes ☐/ No ☐
b. Was the sample screened for human pathogens? Yes ☐/ No ☐
If yes, what were the results? Positive ☐/ Negative ☐
c. Does the sample donor harbor or do you have any reason to believe the sample donor
harbors a human pathogen? Yes ☐/ No ☐
3. Were the cells transformed with a virus? Yes ☐/ No ☐
a. If yes, what virus?
b. Is virus inactive or has it been rendered non-infectious or replication deficient? Yes ☐/ No ☐
4. Were the cells genetically engineered in any way other than viral transformation? Yes ☐/ No ☐
I have read the above questions carefully and certify the information provided to be correct.
helmk\sorting infectious samples\UCCC Cell Sorting Sample Biosafety Form 070611