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Biological Safety Permit New Application

  1. Biological Safety Permit New Application

    Fee: $750.00

    You can pay this fee on our website through "Online Payments" or by check made out to "Town of Burlington" and mailed to: Burlington Board of Health 61 Center Street Burlington, MA 01803

  2. This Application is for (check all that apply)*
  3. On-Site Emergency Facility Contact Information

  4. Biological Safety Officer Contact Information (if different from above)

  5. Corporate Officer Authorized to Sign Application

  6. *From Burlington BOH Protocol Form. This form must be submitted for every protocol. 

  7. NIH Risk Group*
  8. Biosafety Containment Level*
  9. Reviewed and Approved by IBC*
  10. Check boxes below to confirm the following new permit application requirements have been met/attached. Refer to the Burlington Board of Health Biological Safety Regulations for specific requirements.

  11. Submit the following with new application

    **Note:  Discussion of Permit Approval will be placed on a regularly scheduled BOH meeting agenda by the Director of Public Health when BOH staff has completed application review of submitted materials and all information has been received.

  12. Please upload any additional attachments to include with application.

  13. FOR LABORATORIES USING BSL-3 CONTAINMENT OR RISK GROUP 3 AGENTS, SEE ADDITIONAL PERMIT APPLICATION REQUIREMENTS IN THE BOARD OF HEALTH BIOLOGICAL SAFETY REGULATIONS


    By signing below I hereby certify:

    1. All research or manufacturing involving Regulated Biological Agents as defined by the Burlington Board of Health Biological Safety Regulations shall be undertaken only in strict conformity with the National Institutes of Health (NIH) Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules, if applicable, the current edition of the Centers for Disease Control (CDC) Biosafety in Microbiological and Biomedical Laboratories (BMBL), and all other health regulations of the Board of Health;
    2. The facility will allow access for site inspections by the Burlington Board of Health; and, 
    3. The facility will provide a written summary of any incidents/adverse events in accordance with the Burlington Board of Health Biological Safety Regulations, Section 6G, if applicable.
  14. This is an electronic signature to submit your application, there is no need to print or download this form for a physical signature.

  15. Leave This Blank:

  16. This field is not part of the form submission.