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Environmental Health & Safety

 

Poliovirus Report Form (EHS 7-9)

Marked fields are required.

To ensure Florida State University is in compliance with the reporting requirement to U.S. National Authority for Containment of Poliovirus (U.S. NAC), the University would need to implement safety and security information for identifying and reporting poliovirus (PV) and/or potentially infectious materials (PIM) that may contain PV. If you or your laboratory have any PV or PIM that may contain PV, please contact the Biological Safety Office for additional reporting requirement information.

Principal Investigator:
PI Title:
Department:
Building:
Room:
Campus Phone:
Email:
NO, My laboratory does not possess any potentially infectious material of any poliovirus serotype.
OR
YES, My laboratory does possess materials or potentially infectious materials that may contain poliovirus serotype. I will contact the Biological Safety Office for additional reporting requirement information.
Comments: