Deadline: 30th of August 2013

Submission method: email form to the correct email list for your region:

safety_forms_asia@igem.org

safety_forms_europe@igem.org

safety_forms_north_america@igem.org

safety_forms_latin_america@igem.org

Students can complete this safety form, but it must be read and signed (electronic or hard copy) by your team's faculty advisor. Your advisor must verify the information contained in this form and sign it.

The iGEM Safety Committee must be able to easily reach the advisor with questions or other follow-up communication. If you have made changes to your project (new coding regions or organisms) you must resubmit your safety form before wiki freeze (date TBD).

Key points to remember as you complete the safety assessment process:

• • For help in completing questions 1 and 2, you may find it useful to consult the Risk Groups section of the Safety Resources List [2013.igem.org/Safety].
• • The iGEM Safety Committee will be reviewing your project. To avoid temporary suspensions, answer these questions completely and accurately.
• • The Safety Committee needs to be able to communicate with your faculty advisor about any safety concerns. If we cannot reach your advisor in a reasonable amount of time, you may be subject to restrictions at the Jamboree.
• • Your safety page, wiki project page and poster should be consistent with each other. If you change your project, submit an updated Basic Safety Page to the iGEM Safety Committee before the wiki freeze. (Your faculty advisor must also read and sign the updated page.)
• • We understand that projects may still be changing at a late date. However, large discrepancies between what you submit on the Basic Safety Page and what you present at the Jamborees may result in restrictions at the Jamboree.

Basic Safety Questions for iGEM 2013

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a. Please describe the chassis organism(s) you will be using for this project. If you will be using more than one chassis organism, provide information on each of them:

	Species	Strain no/name	Risk Group	Risk group source link	Disease risk to humans? If so, which disease?
Ex	E. coli (K 12)	NEB 10 Beta	1	www.absa.org/riskgroups/bacteria search.php?genus=&species=coli	Yes. May cause irritation to skin, eyes, and respiratory tract, may affect kidneys.
1	E.coli (K-12)	MG1655	1	www.atcc.org/products/all/700926.aspx	No.
2	Bacteriophage	P1	1	http://www.absa.org/abj/abj/101501Verh eust.pdf	No.
3
4
5
6
7
8

*For additional organisms, please include a spreadsheet in your submission.

2. Highest Risk Group Listed:

If you answered 1+, please also complete the iGEM Biosafety form part 2 for any organisms in this category.

3. List and describe all new or modified coding regions you will be using in your project. (If you use parts from the 2013 iGEM Distribution without modifying them, you do not need to list those parts.)

	Part number.	Where did you get the physical DNA for this part (which lab, synthesis company, etc)	What species does this part originally come from?	What is the Risk Group of the species?	What is the function of this part, in its parent species?
Ex	BBa_C0040	Synthesized, Blue Heron	Acinetobacter baumannii	2	Confers tetracycline resistance
1	BBa_K101 5000	Molecular genetics laboratory, Tokyo Metropolitan University	E.coli K-12 MG1655	1	replication of plasmid, reguration of plasmid copy number
2	BBa_K101 5001	Invitrogen	E. coli K-12 MG1655	1	DNA-binding transcriptional dual regulator
3	BBa_K1015 005,K1015007	Molecular genetics laboratory , Tokyo Metropolitan University	E. coli K-12 MG1655	1	transcriptional operon
4	BBa_K1015 006,K1015007	Molecular genetics laboratory, Tokyo Metropolitan University	E. coli K-12 MG1655(by pSC101cloning vecter)	1	tetracycline resistance
5	BBa_K101 5001	Molecular genetics laboratory, Tokyo Metropolitan University	E. coli K-12 MG1655	1	repress pLac
6	BBa_K101 5002	Molecular genetics laboratory, Tokyo Metropolitan University	Tn9	1	Chloramphenicol resistance
7	BBa_K101 5002	Molecular genetics laboratory, Tokyo Metropolitan University	Tn903	1	Kanamycin 　resistance
8	BBa_K101 5003	Molecular genetics laboratory, TMU	pI208 from S.aureus	2	Ampicillin resistance