Instructions: List ALL personnel working with animals on this (co-investigators, postdoctoral fellows, students, research assistants, and technicians). If conducting highly technical activities (e.g., perfusion, cervical dislocation without anesthesia), please indicate personnel responsible for these activities and include their related training/experience. PI : _ Responsibilities Check [X] all that apply. [ ] Anesthesia [ ] Injections [ ] Surgery survival – [ ] Animal Handling [ ] Perfusion [ ] Surgery non-survival – [ ] Euthanasia [ ] Peri- or post-operative monitoring [ ] Decapitation [ ]Additional Responsibilities _ Experience: List individual’s previous training and experience using animals, including species information, identifying procedures and experience level (e.g., how many years). List where PhD was obtained, the year, and area of discipline. Include where and by whom training was provided. _ Training: Indicate who will provide current training and for which procedures. Include the qualifications of the trainer. How will skill level and/or proficiency be determined? What are the qualifications for an individual to work independently? _ BIACUC-CITI courses: Check [X] all that apply. [ ] Investigators, Staff and Students, Basic Course (All personnel to complete.) [ ] IUEHS Safety & Health for Animal Users Training (All personnel to complete.) species as appropriate: [ ] Working with Rats [ ] Working with Mice [ ] Working with Dogs [ ] Working with Rabbits [ ] Working with Hamsters [ ] Working with Amphibians Training by Laboratory Animal Resources Personnel: [ ] Aseptic surgery (Required prior to participating in any surgical procedures.) - Medical Clearance to Work with animals: Select Researcher Survey” “Animal [ ] Medical Surveillance Questionnaire and follow-up (All personnel to complete.) EHS Safety Training: [ ] EHS Safety Training
Instructions: List ALL personnel working with animals on this (co-investigators, postdoctoral fellows, students, research assistants, and technicians). If conducting highly technical activities (e.g., perfusion, cervical dislocation without anesthesia), please indicate personnel responsible for these activities and include their related training/experience. PI : _ Responsibilities Check [X] all that apply. [ ] Anesthesia [ ] Injections [ ] Surgery – survival [ ] Animal Handling [ ] Perfusion [ ] Surgery – non-survival [ ] Euthanasia [ ] Peri- or post-operative monitoring [ ] Decapitation [ ]Additional Responsibilities _ Experience: List individual’s previous training and experience using animals, including species information, identifying procedures and experience level (e.g., how many years). List where PhD was obtained, the year, and area of discipline. Include where and by whom training was provided. _ Training: Indicate who will provide current training and for which procedures. Include the qualifications of the trainer. How will skill level and/or proficiency be determined? What are the qualifications for an individual to work independently? _ BIACUC-CITI courses: Check [X] all that apply. [ ] Investigators, Staff and Students, Basic Course (All personnel to complete.) [ ] IUEHS Safety & Health for Animal Users Training (All personnel to complete.) species as appropriate: [ ] Working with Rats [ ] Working with Mice [ ] Working with Dogs [ ] Working with Rabbits [ ] Working with Hamsters [ ] Working with Amphibians Training by Laboratory Animal Resources Personnel: [ ] Aseptic surgery (Required prior to participating in any surgical procedures.) Medical Clearance to Work with animals: - Select “Animal Researcher Survey” [ ] Medical Surveillance Questionnaire and follow-up (All personnel to complete.) EHS Safety Training: [ ] EHS Safety Training
iub-biacuc-protocol-application-form.docx