Personnel. Complete the table below for each individual who will be involved in any of the surgeries on this protocol. Role in Surgery Surgery #(s) Name (see Other (describe) Item 1) Manage Surgeon Assistant Anesthesia ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Location of surgery. Complete the table below for each location where surgery on this protocol will be performed. Type of Space Surgery Other Room #(s) Dedicated Building Dedicated Space not Number (see Surgical Surgical Dedicated Item 1) Facility Space to Surgery ( ) ( )* ( )* ( ) ( *) ( )* ( ) ( )* ( )* ( ) ( )* ( )* *For each space that is not in a dedicated surgical facility, provide the justification for using this space for surgery on this protocol ► Pre-operative protocol. Pre-operative procedures. Complete the table below for each pre-operative procedure that will be performed to prepare the animal(s) for surgery.
Personnel. Complete the table below for each individual who will be involved in any of the surgeries on this protocol. Name Surgery #(s) (see Item 1) Role in Surgery Surgeon Assistant Manage Anesthesia Other (describe) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Location of surgery. Complete the table below for each location where surgery on this protocol will be performed. Building Room Number Surgery #(s) (see Item 1) Type of Space Dedicated Surgical Facility Dedicated Surgical Space Other Space not Dedicated to Surgery ( ) ( )* ( )* ( ) ( *) ( )* ( ) ( )* ( )* ( ) ( )* ( )* *For each space that is not in a dedicated surgical facility, provide the justification for using this space for surgery on this protocol ► Pre-operative protocol. Pre-operative procedures. Complete the table below for each pre-operative procedure that will be performed to prepare the animal(s) for surgery.
AnimalComponentOfResearchProtocol.docx