HomeMy Public PortalAboutBiotechReg_Registration_App fill_202110181003586465Larry Ramdin
Director of Public Health
TOWN OF WATERTOWN
Health Department
Administration Building
149 Main Street
Watertown, MA 02472
Phone: 617-972-6446
Fax: 617-972-6499
www.watertown-ma.gov
Registration of Recombinant DNA (rDNA) use by Low -Risk Facilities
Please provide electronic version of your application and supporting documents
To the Watertown Board of Health:
The undersigned seek to register our use of rDNA pursuant to the Town of Watertown's Board of
Health regulation: Biotechnology and the use of Recombinant DNA Molecule Technology.
Biosafety Containment Level: BSL 1 BSL 2
Institution / Company Information:
Name of the Institution:
Address:
Mailing Address (If Different):
Phone: Fax:
Email:
Date of Occupancy:
Institutional Official / Responsible Official / Chief Executive Officer (CEO):
Name:
Work Address:
Phone (Office):
Email:
Phone (cell):
❑Check if contact person for permit -related communication
Contact Person (if not selected above):
Name:
Work Address:
Phone (Office):
Email:
Phone (cell):
Registration application for Low -Risk rDNA Facilities (October 2021)
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Please provide the following documentation:
❑ Completed and signed use of rDNA registration form.
❑ Check or money order payable to the Town of Watertown for $100.
❑ Name and curriculum vitae of a person in the organization familiar with the proposed
rDNA Work and with the NIH Guidelines.
❑ Summary from the above -named person describing the proposed work and stating the:
a. name and type of organisms (host/donor [foreign DNA]/vector) being used.
b. reference to the section of the NIH Guidelines where the work falls.
c. approximate percentage of viral genome present, if rDNA containing eukaryotic viruses are
propagated in cells.
d. scale (in liters) on which the organisms will be grown.
❑ Name of biological waste handler (if any) and written assurance that all waste will be
disposed of according to all applicable federal, state, and local codes.
Description of annual safety training and refresher training provided to laboratory staff.
Agreement and Signature
1. We, the undersigned, do hereby certify and affirm that all the information provided in this application,
including all attached documents, is true and accurate to the best of our knowledge and belief.
2. We certify that we shall conduct work specified in this application in compliance with the Town of
Watertown's Board of Health regulation entitled Biotechnology and the use of Recombinant DNA
Molecule Technology.
3. We understand that, under the above -mentioned regulation, only facilities that have a biosafety
contentment level no higher than BSL-1, and are defined as a Low Risk Facility, are allowed to register
in place of seeking a permit.
4. We understand that an amendment to this registration must be sought prior to annual renewal in the
following instances: move to a new location within the Town of Watertown, physical expansion of lab
space within current facilities, creation of additional lab space at another location in the Town of
Watertown, and/or the addition of Large -Scale activities as defined in Appendix K of the NIH
Guidelines. Amendments to the registration must be approved before the above -mentioned changes
can proceed.
5. We are aware that an increase in containment level above BSL-1 requires us to seek a permit prior to
the commencement of work.
6. We agree and consent to inspection of our facilities, procedures, and practices in order to confirm
compliance with the above -mentioned regulation and all applicable federal, state and local laws by the
Board or Health or its Agents at reasonable times. Inspections may be conducted annually or with
greater frequency if deemed necessary by the Board of Health.
Institutional Official / Responsible Official / CEO Date
(Signature)
Institutional Official / Responsible Official / CEO (Printed) Date
Registration application for Low -Risk rDNA Facilities (October 2021)
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