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MIT.nano CryoEM sample registration (revised)

MIT.nano CryoEM sample registration (revised)

General Information

Last name:

First name:

Email address:

MUMMS username:

You must set up a MUMMS account to use the CryoEM Facility (https://nanolms.mit.edu/mumms/registration.html).

Principal Investigator (PI):

PI's Email address:

Institution:

Department:

Pre-screening

Have you previously registered this specimen material and its components for use in the cryo-EM facility?

The sample name must match a previously registered sample.

Yes

Thank you for already registering your sample!

After you receive sample approval, please proceed to the CryoEM session request form

Sample Information

Use this form for each new sample you would like to bring into the CryoEM facility for specimen preparation and/or imaging (Bioprep Lab, Aquilos, Talos Arctica, Titan Krios). To register multiple samples you will need to submit the form more than once.

Sample name that you will prepare and/or image.

This should be a unique identifyer for your sample. You will be prompted to include a more thorough sample description in the next question.

Describe your sample.

Be descriptive (e.g. organism, species and genus, strain, variant, protein name, cell line, expression source, non-biological organic or inorganic material, etc.). For example, human XYZ complex extracted from E. coli, S. cerevisiae transformed with pRS415MET25-GFP, lead sulfide nanoparticles with oleic acid surfactant.

Will your sample already frozen on a TEM grid prior to bringing it into the MIT.nano CryoEM facility?

Yes

Is your sample biological, derived/isolated from a biological system (e.g. cell or organism), or recombinant or synthetic nucleic acid molecules (e.g. DNA/RNA)?

Yes

Biological Sample Information

Which categories best describe your sample?

Please select all that apply.

Recombinant or synthetic nucleic acid molecules (rDNA, RNA or SNA)

Purified protein, nucleic acid molecules (DNA or RNA), or other isolated material from a biological source

Recombinant organisms or cells

Non-recombinant microorganism (e.g. bacteria, protozoa, virus, fungus)

Animal sourced materials (e.g. tissues from Non-Human Primate, insect, rodent, fish, reptiles)

Human sourced materials (e.g. stem cells (hESC, iPSC), established cell lines, blood, serum, brain, or other tissues)

Biological toxins (e.g. Select Toxins)

Prion proteins

Other — Sample does not fit the categories above

Please specify

Is your sample purified or crude?

Purified

Crude extract

Is your sample biologically inactivated and poses no hazards to personnel and the environment?

Yes

Please select the method used to inactivate the specimen.

Heat killed

Dried/dehydrated

Paraffin-embedded

Chemical fixative

Other

Please specify

Are you an internal or external user?

Internal MIT user

External user (including the Broad and Whitehead Institutes)

Is this biological sample or research registered with the MIT CAB/ESCRO?

The Committee on Assessment of Biohazards and Embryonic Stem Cell Research Oversight (CAB/ESCRO) ensures the safe and responsible conduct of biological research at MIT. Visit the CAB/ESCRO website or contact your Biosafety Officer to determine if your sample or research requires registration (https://ehs.mit.edu/about/institute-committees/cab-escro-committee/).

Yes

N/A - Exempt from CAB/ESCRO oversight

Is this biological sample or research registered with the MIT CAB/ESCRO through a MIT collaborator's Biological Research Registration (BRR)?

Yes

N/A - Exempt from CAB/ESCRO oversight

The Committee on Assessment of Biohazards and Embryonic Stem Cell Research Oversight (CAB/ESCRO) ensures the safe and responsible conduct of biological research at MIT. Visit the CAB/ESCRO website to determine if your sample or research falls within the purview of the CAB/ESCRO (https://ehs.mit.edu/about/institute-committees/cab-escro-committee/).

Please enter 3 digit BRR number.

Contact your MIT Biosafety Officer if you do not know your lab's BRR number.

Biological Research Registration (BRR) is required.

Please contact your Biosafety Officer to assist with the BRR process. Your sample registration for the MIT.nano CryoEM Facility will remain under review until you have received CAB/ESCRO approval to work with this biological material.

Biological Research Registration (BRR) is required.

If your biological sample is not already registered on MIT.nano's BRR, we will work with you to add it to our BRR for CAB/ESCRO review. Your sample registration for the MIT.nano CryoEM Facility will remain under review until we have received CAB/ESCRO approval to work with this biological material.

Please enter your collaborator's 3 digit BRR number.

Have your collaborator contact their MIT Biosafety Officer if you they do not know the lab's BRR number.

Which of the following describes your sample?

Not infectious or pathogenic, and not toxic. Poses no hazard on exposure or for disposal.

Risk Group 1 (RG1) organisms. Pose low risk to healthy adult humans.

Risk Group 2 (RG2). Pose moderate risk to healthy individuals.

If available, attach data sheets for your specimen with any test data (e.g. certificate of analysis) for bloodborne pathogens and other documentation that may assist in the analysis.

If available, attach data sheets for your specimen with any test data (e.g. certificate of analysis) for bloodborne pathogens and other documentation that may assist in the analysis.

One file only.
20 MB limit.
Allowed types: jpg, jpeg, png, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Additional Sample Information

We will work with you to establish procedures for your specimen that ensure safety for all users of the facility.

Is your sample a nanomaterial or contain nanomaterials (material with at least one dimension <100 nm)?

Yes

Which additional hazards are not described in the above questions?

Biological

Chemical

Radiological

Other

Please describe the additional biological, chemical, radiological, or other hazards in your sample.

Be descriptive. Provide enough information to permit reasonable understanding by a lay person & to allow for risk assessment.

Select method(s) of decontamination and/or disinfection appropriate for your sample.

Please select all that apply.

Simple Green

10% Bleach

Cavicide

PREempt

70% Ethanol

Other

Please specify.

Select method(s) of waste disposal appropriate for your sample.

Please select all that apply.

Biowaste box

Chemically-contaminated solids

I will take waste back to my PI's lab.

Other

Please specify.

I understand that checking this box indicates that I have answered all of the above questions to the best of my knowledge and that I agree to only bring properly approved materials into MIT.nano. I will follow all policies and procedures outlined in MIT.nano documentation and training. If found out of compliance, I understand this may result in loss of access to MIT.nano facilities.

I understand