Cell Sorting Experiment Form
Date requested to conduct cell sorting
Anesthesiology and Perioperative Medicine
Biochemistry and Molecular Biology
Cellular and Molecular Physiology
Family and Community Medicine
Microbiology and Immunology
Neural and Behavioral Sciences
Obstetrics and Gynecology
Pathology and Laboratory Medicine
Physical Medicine and Rehabilitation
Public Health Sciences
PI first name
PI last name
PI phone number
Sample preparer first name
Sample preparer last name
Sample preparer email
Sample preparer phone number
Approvals and Safety
BSRD Assurance Form number for these cells
BSL assigned to these cells
Were these same cells/pathogens previously approved by Flow Cytometry Core for sorting?
Cell and Experiment Information
What is the origin? (i.e., marrow, blood, tissue type)
Any known infections?
What is the ATCC number?
Are there any potential infectious agents associated with the cells (virus, bacteria, parasite, strains, modifications)?
Please explain any potential infectious agents
Are there any recombinant infectious agents associated with the cells (retrovirus, lentivirus, replication competent/defective, tropism, oncogenes, etc.)?
Please explain any recombinant infectious agents; documentation must be attached.
Please attach documentation about any recombinant infectious agents
List genes to be expressed from recombinant constructs
Are any constructs used that reduce expression of a tumor suppressor gene?
Please identify this gene
Do these genes encode any recombinant proteins with potential oncogenic properties?
What are these proteins?
Are these cells fixed?
By what method?
Are the fixed cells virally infected?
Do you have documentation of eliminated hazard potential for humans? (Does this fixation kill all pathogens in the sample?)
Please upload documentation of eliminated hazard potential
Do you agree to follow the biosafety protocols in the Flow Cytometry Core?
Fluorochromes to be used
Total volume of sample to be run and concentration of cells
Desired number of target cells to be collected
Approximate size of cells to be sorted
Size of conical tube to sort into
Your submission of this form indicates that the principal investigator has verified review of this sorting experiment and the accuracy of its responses. Both the preparer and the PI will receive an email copy of all submitted information.
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