Provide comprehensive identification and risk characterization for all biological materials proposed for transfer. Accurate classification is critical for determining packaging, transport, and containment requirements.
Primary Sample Material ID Number
Additional Sample Alias or Internal Tracking Code
Scientific Name of Biological Agent (Genus and Species)
Strain Designation or Isolate Identifier
WHO Risk Group Classification
Risk Group 1 (no or low individual and community risk)
Risk Group 2 (moderate individual risk, low community risk)
Risk Group 3 (high individual risk, low community risk)
Risk Group 4 (high individual and community risk)
Justification for RG3 classification and specific high-risk characteristics:
Justification for RG4 classification and specific high-risk characteristics:
Does this material contain genetically modified organisms (GMOs) or recombinant nucleic acids?
Select all applicable genetic modification categories:
Insertion of virulence factors
Antimicrobial resistance markers
Enhanced transmissibility modifications
Toxin expression systems
Gene knockouts or deletions
Reporter gene insertions (e.g., GFP, luciferase)
Other modification
Is this agent known to produce toxins or biologically active metabolites?
Specify toxin type, concentration, and LD50 if known:
Does this agent exhibit zoonotic potential or cross-species transmission capability?
Identify known susceptible host species:
Humans
Non-human primates
Rodents
Livestock (cattle, sheep, pigs)
Avian species
Marine mammals
Other vertebrates
Estimated Infectious Dose (ID50) in laboratory model if known
Infectious Dose Unit
Has this material been inactivated or attenuated?
Describe inactivation method, validation protocol, and verification data:
Brief description of material composition and matrix
Total volume or mass of material to be transferred
Volume/Mass Unit
Number of individual containers/vials in shipment
Does material require any special handling beyond standard BSL practices?
Specify special handling requirements:
Complete identification and verification of all facilities and responsible personnel involved in the transfer. International transfers require additional documentation.
Sending Institution/Laboratory Full Legal Name
Sending Facility Complete Physical Address
Sending Facility BSL Level Certification
Sending Principal Investigator Full Name
Sending PI Professional Title/Position
Sending PI Email Address
Sending PI Direct Phone/24-Hour Emergency Contact
Sending Facility Biosafety Officer Name
Sending Facility BSO Email and Phone
Is this an international transfer across national borders?
Select all applicable international transfer frameworks:
UN Model Regulations for Infectious Substances
IATA Dangerous Goods Regulations
Import/Export permit required
Material Transfer Agreement (MTA) in place
Nagoya Protocol compliance for genetic resources
Receiving Institution/Laboratory Full Legal Name
Receiving Facility Complete Physical Address
Receiving Facility BSL Level Certification
Receiving Principal Investigator Full Name
Receiving PI Professional Title/Position
Receiving PI Email Address
Receiving PI Direct Phone/24-Hour Emergency Contact
Receiving Facility Biosafety Officer Name
Receiving Facility BSO Email and Phone
Has the receiving facility confirmed BSL compatibility and adequate containment capabilities?
WARNING: Transfer cannot proceed until receiving facility confirms adequate containment capabilities. Please provide documentation of facility upgrade plans and interim safety measures.
Verify complete compliance with triple packaging system requirements and cold-chain integrity. All packaging must meet UN standards for infectious substance transport.
Primary Container Type (Leak-proof Primary Receptacle)
Sealed cryovial with O-ring
Screw-capped tube with gasket
Sealed ampoule
Vacuum-sealed pouch
Other certified primary container
Primary Container Material and Volume Capacity
Is primary container individually wrapped in absorbent material?
CRITICAL: Primary containers must be wrapped in sufficient absorbent material to contain entire contents in case of leakage. Transfer cannot proceed without this requirement.
Secondary Packaging Type (Water-tight Leak-proof Receptacle)
Secondary Packaging UN Certification Number
Does secondary packaging contain sufficient absorbent for all primary containers?
Outer Packaging Type (Rigid Protective Outer Receptacle)
Outer Packaging UN Specification Marking
Is complete triple packaging system certified for air transport (IATA PI 620 or PI 650)?
Packaging must meet IATA dangerous goods specifications for air transport. Ground-only transport requires alternative documentation.
Temperature Maintenance Requirements During Transit
Ambient temperature (15-25°C)
Refrigerated (2-8°C)
Frozen (-20°C)
Deep frozen (-80°C)
Cryogenic (liquid nitrogen, -196°C)
Controlled room temperature with monitoring
Are validated gel packs or refrigerated shippers used?
Refrigerated shipments require validated cooling systems. Ambient shipping not permitted for temperature-sensitive materials.
Are dry ice shipments properly labeled and within quantity limits?
Dry ice shipments require Class 9 dangerous goods labeling and quantity restrictions per package.
Is dry ice packaging sufficient for 96+ hour transit?
Is liquid nitrogen dry shipper certified for air transport?
Liquid nitrogen dry shippers must be certified as non-pressurized and comply with IATA special provision A152.
Is a temperature monitoring device (data logger) included in shipment?
Temperature Logger Serial Number and Alarm Setpoints
Have all exterior surfaces of outer packaging been decontaminated?
Decontamination Method and Verification
Are complete shipping documents externally attached in document pouch?
All shipping documents must be readily accessible without opening package. Transfer cannot proceed.
I certify that packaging has been inspected and meets all triple packaging system requirements
Detailed transport logistics and emergency response preparedness are mandatory for all biological material transfers, especially for Risk Group 3 and 4 agents.
Primary Mode of Transport
Commercial air freight (passenger aircraft)
Commercial air cargo (dedicated freighter)
Ground courier (dedicated vehicle)
Ground postal service (registered)
Hand-carried by authorized courier
Ship/sea freight
Does carrier accept Category A infectious substances (UN 2814/2900)?
Many commercial airlines restrict Category A infectious substances. Alternative carrier required.
Provide courier authorization credentials and justification for hand-carry:
Carrier Company Name and Account Number
Carrier Emergency Contact Number (24-hour)
Scheduled Shipment Departure Date and Time
Estimated Total Transit Duration (hours)
Will shipment transit through intermediate handling facilities or customs checkpoints?
List all intermediate handling points and estimated dwell times:
Is shipment equipped with GPS real-time tracking?
GPS Tracking Device ID and Monitoring Platform
EMERGENCY SPILL CONTINGENCY - Complete for all Risk Group 2, 3, and 4 materials
Has a written Emergency Action Plan (EAP) been provided to carrier?
Carrier must receive written Emergency Action Plan before accepting shipment. Transfer cannot proceed.
Spill Response Kit Contents and Location During Transit
24-Hour Emergency Contact for Spill Response (Primary)
24-Hour Emergency Contact for Spill Response (Secondary)
Nearest Qualified Decontamination Facility to Transit Route
Has carrier personnel received biohazard spill response training?
Carrier must demonstrate competency in infectious substance spill response. Provide training certificates or select alternative carrier.
Communication Protocol in Case of Transit Delay, Temperature Excursion, or Spill Event
Are there any geopolitical restrictions or sanctions affecting this transfer route?
Describe compliance measures and alternative routing:
Final authorization requires documented IBC approval, comprehensive risk assessment, and sign-off from all responsible authorities. Transfer cannot proceed without complete documentation.
Sending Facility IBC Approval Reference Number
Sending Facility IBC Approval Date
Sending Facility IBC Approval Expiration Date
Does sending IBC approval specifically authorize this material transfer?
Separate IBC amendment or new approval required. Transfer cannot proceed.
Receiving Facility IBC Approval Reference Number
Receiving Facility IBC Approval Date
Receiving Facility IBC Approval Expiration Date
Does receiving IBC approval specifically authorize receipt and possession of this agent?
Receiving facility must obtain specific IBC approval for this material before transfer can proceed.
Has a comprehensive Material Transfer Agreement (MTA) been executed between institutions?
MTA must be in place before transfer. Standard MTA templates are available through UBMTA or individual institutional technology transfer offices.
Upload complete risk assessment documentation for this transfer
Does this transfer involve any dual-use research of concern (DURC) considerations?
Describe DURC mitigation measures and oversight committee review:
Have all personnel involved in packaging and transport received agent-specific safety training?
Training records must be documented and available for inspection. Transfer cannot proceed.
Final Packaging Inspection and Sign-off Timestamp
I certify that all information provided is accurate and complete to the best of my knowledge
I acknowledge that incomplete or inaccurate information may result in transport delays, regulatory violations, or biosafety incidents
I confirm that emergency response procedures have been communicated to all parties and are readily accessible during transit
Sending Principal Investigator Digital Signature
Sending Facility Biosafety Officer Digital Signature
Receiving Principal Investigator Digital Signature (Pre-receipt Acknowledgment)
Receiving Facility Biosafety Officer Digital Signature (Pre-receipt Verification)
Final IBC Administrative Review and Authorization Timestamp
Institutional Biosafety Committee Chair or Designated Reviewer Signature
Final Authorization Reference Code
To configure an element, select it on the form.