Environmental Health and Safety

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Select Agent Registration Form

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The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, Subtitle A of Public Law 107–188 requires the Department of Health and Human Services (HHS) to establish and regulate a list of biological agents and toxins that have the potential to pose a severe threat to public health and safety.

The Agricultural Bioterrorism Protection Act of 2002 requires the United States Department of Agriculture (USDA) to establish and regulate a list of biological agents that have the potential to pose a severe threat to animal health and safety, plant health and safety, or to the safety of animal or plant products (Select Agents).

In order to ensure that the University is in compliance with these regulations, all Principal Investigators who are using any Select Agent must register with the Department of Environmental Health and Safety using this form.

A complete list of Select Agents and Toxins is available here.

Principal Investigator:
PI Title:
Department:
Building:
Room:
Campus Phone:
Email:

I do not have or plan to have any Select Agents, Toxins, or High Consequence Livestock Pathogens in my laboratory.

OR

I have or plan to have Select Agents, Toxins, or High Consequence Livestock Pathogens in my laboratory.

List 1: HHS Select Agents and Toxins
Agent	Concentration	Quantity

List 2: Overlap Select Agents and Toxins
Agent	Concentration	Quantity

List 3: USDA Select Agents and Toxins
Agent	Concentration	Quantity

List 4: USDA Plant Protection and Quarantine (PPQ) Select Agents and Toxins
Agent	Concentration	Quantity

Comments: