BIACUC Protocol Form 2012 ver 1.3

Document Sample
BIACUC Protocol Form 2012 ver 1.3 Powered By Docstoc
					                                                                                                    PROTOCOL #          00-000
                                 ANIMAL CARE AND USE PROTOCOL                                      APPROVED:
                                                                                                   EXPIRES:
                                                                                                                 OFFICE USE ONLY


ADMINISTRATIVE DATA
This submission is a (check [X] one):
        [ ] New Study
        [ ] Renewal: Previous protocol: [# ] Expires [DATE]
        [ ] Major Amendment - Complete Amendment Record below
        [ ] Minor Amendment - Complete Amendment Record below

Project Title: _

Project Type (check [X] one):            [ ] Research      [ ] Teaching          [ ] Breeding    [ ] Contract
                                         [ ] Other, please describe _

Funding Source(s): _
Grant Title(s): _

Principal Investigator: _
Position (check [X] one):        [ ] Tenure track/clinical professor [ ] Research Scientist    [ ] Lecturer        [ ] Emeritus
                                 Only individuals of the above ranks may serve as PIs on protocols. All electronic communications
                                 regarding protocol submissions must be generated by or copied to the PI.
Email: _
Department: _
Phone: _
Emergency after-hours phone: _
Campus Address: _

Co-PI (if applicable): _
Position (check [X] one):        [ ] Tenure track/clinical professor [ ] Research Scientist     [ ] Lecturer       [ ] Emeritus
                                 [ ] Postdoctoral Fellow [ ] Visiting Scientist        [ ] Research Associate      [ ] Graduate Student
                                 [ ] Technician
Email: _
Department: _
Phone: _
Emergency after-hours phone: _
Campus Address: _

Does this study involve live animal use at another campus or institution?                [ ] yes [ ] no
         If yes, please explain: _


OFFICE USE ONLY


                                                    BIACUC Chair or Authorized
  Approved on:                                                       Signature


  Conditions or modifications:
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                            # 00-000




CONTENTS: This application consists of two parts: The following REQUIRED sections (1-8), and the additional sections (A-I). Your
answers to the required sections will help to determine which, if any, additional sections you will need to complete.



      REQUIRED SECTIONS

                Amendment Record (for amendments only)

          1.    Animal Requirements & Husbandry

          2.    Rationale for Involving Animal Subjects

          3.    Purpose of Proposed Research

          4.    Description of Experimental Design and Animal Procedures

          5.    Experimental Manipulations

          6.    Assurance that Proposed Work Does Not Unnecessarily Duplicate Previous Research

          7.    Teaching Proposals

          P.    Project Personnel




       ADDITIONAL SECTIONS

          A. Surgery

          B.    Anesthesia

          C.    Minimization of Pain and Discomfort

          D. Experimentally Induced Disease or Condition -

          E.    Euthanasia

          F.    Hazardous Substances

          G. Breeding, Ordering, or Using Pregnant Animals

          H. Standard Operating Procedure (SOP) for Investigator Maintained Animals

          I.    Pain & Distress Rating Scale Template




BIACUC.protocol.2012-ver 1.3                                                                                                  Page 2
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                        # 00-000



AMENDMENT RECORD
   a. If this application is an amendment to a previously approved protocol, incorporate your requested changes in your protocol
      by using the Track Changes option in this WORD document. If you prefer not to use this method, then highlight changes
      with different color text, or with the highlight tool and be sure that deleted text is changed to strikethrough rather than
      simply deleted.
   b. Provide a brief summary of the proposed changes in the section below:


          Date                 Summary

1.         _                   _

2.         _                   _

3.         _                   _

4.         _                   _

5.         _                   _

6.         _                   _

7.         _                   _

8.         _                   _

9.         _                   _

10.        _                   _



                                                                                                        [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                              Page 3
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                              # 00-000



1.        Animal Requirements & Husbandry
          Note: If ordering or using pregnant females in this protocol, indicate the number of pregnant females separate from the
          number of offspring that will be used as subjects. If you will be breeding animals as part of this protocol or ordering
          pregnant animals for use or to produce litters for this protocol, complete Section G: Breeding, Ordering, or Using Pregnant
          Animals

1.A.      Species

                Scientific name          Common name                 # animals              Housing area               Use areas




1.A.1.    Genetically Modified Animals. If any of the above species are genetically modified, list the individual strains below. The
          number of animals/strain should be a subset of the number(s) listed above. Complete section 1.D.4. below.

                               Species                               Strain                                # animals




          NOTE: use of genetically modified animals requires IBC approval. See
          http://researchadmin.iu.edu/Biosafety/IUB/bio_home.html#biosafety

1.A.2.    Carry-over. If this is a three-year renewal, approximately what number of animals will be transferred from the previous
          protocol to this renewal?

                    Species currently in use                         Strain                                # animals




1.B.      Source of Animals

           From where will animals be obtained for this study? Check [x] all that apply.

1.B.1.    [ ] An LAR-approved vendor

             By indicating that you will purchase animals for this study from an approved vendor, you are free to purchase from ANY of
             the vendors approved for your species on the current list. A list of current approved vendors can be downloaded from
             BIACUC Forms web site: http://researchadmin.iu.edu/IACUC/IUB/biacuc_forms.html. LAR does not pre-approve suppliers
             for frogs or fish. If you are requesting one of these species, the requested vendor must be listed below.

1.B.2.    [ ] Bred in-house specifically for this protocol. Complete Section G: Breeding, Ordering, or Using Pregnant Animals –(unless
          animals are bred under another protocol)




BIACUC.protocol.2012-ver 1.3                                                                                                   Page 4
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                  # 00-000



1.B.3.    [ ] Transferred from another IU protocol: #          .
          List all manipulations animals from the above protocol(s) will be subject to prior to transferring them to this protocol

          _
1.B.4.    [ ] Other, please specify: _


1.C.       Transportation

1.C.1.    If animals are not obtained from a commercial vendor, how will animals be transported to IU?

          _
1.C.2     If animals are to be transported between buildings within the IU campus, describe transportation method

          _
1.D.      Husbandry
          Animals must be observed daily (365 days/year) including weekends and holidays

1.D.1.    If LAR staff will not have primary responsibility for daily care, please explain why and complete Section H: SOP for
          Investigator Maintained Animals:

          _
1.D.2.    If the campus veterinary staff will not have primary responsibility for providing medical care, please describe the
          arrangement for providing veterinary medical care. If no care is anticipated please explain (e.g. this is a field study
          consisting of only direct, unobtrusive observation of free-ranging animals under natural conditions):

          _
1.D.3.    If genetically modified animals are to be used (as indicated in section 1.A.1.a) above), describe any phenotypic consequences
          of the genetic manipulations to the animals. Describe any special care or monitoring that the animals will require and
          complete Section D: Experimentally Induced Disease or Condition:

          _
1.D.4.    Will animals be kept for 12 hours or longer at any one time in any area other than a LAR core housing facility?

                    [ ] Yes [ ] No

          If yes, please indicates the location (building and room #), number of animals, and why animals must be kept outside the
          main facility. _

1.D.5.    Will animal care and/or use take place in the wild or at a field site?

                    [ ] Yes [ ] No

          If yes, describe the location(s) where the field study will be performed and/or where captive animals will be housed and
          used.

          _
          [The BIACUC recognizes that it is not always possible to predict at the initiation of field studies all potential observation or
          collection opportunities. PIs must inform the IACUC of new location opportunities as they develop by submitting an
          amendment to their Animal Use Protocol.]




BIACUC.protocol.2012-ver 1.3                                                                                                        Page 5
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                               # 00-000



1.D.6.     If you answered yes to 1.D.5. above, do you agree to comply with all regulations pertaining to the animals at the field site,
          including whether they are considered endangered or threatened, and will you obtain all applicable permits before
          initiating the study?

                    [ ] Yes [ ] No

          If no, explain: _

                                                                                                               [return to table of contents]

2.        Rationale for Using Animal Subjects

2.A.      Explain your rationale for animal use:
          _


2.B.      Justify the appropriateness of the species selected. What characteristics make it appropriate?
          _


2.C.      Justify the number of animals to be used. List how the number of animals needed was determined by detailing the various
          experimental groups of animals that will be used. The use of tables or other graphics are encouraged and can be inserted
          here. [The number of animals should be the minimum number required to obtain statistically valid results.]:
          _


                                                                                                               [return to table of contents]

3.        Purpose of Proposed Research
          Please provide a brief description of your research project in terms readily understandable by lay-persons in which you
          outline the purpose of your research and justify your use of animal research subjects. Include at least one sentence
          explaining why the study is important to human or animal health, the advancement of knowledge, or the good of society.
          _

                                                                                                               [return to table of contents]

4.        Description of Experimental Design and Animal Procedures
          Describe the goal of the project, briefly state the hypothesis to be tested, the background knowledge that is necessary to
          understand why the work is important and a summary of the experimental methods. Describe only those methods and
          procedures that involve the use of live animals such as (but not limited to):
           methods of identification;
           volumes and frequency of collections of bodily fluids;
           experimental injections or inoculations;
           names, dosages, and routes of administration of test compounds and other materials administered;
           animal (including behavioral) manipulations;
           experimental endpoints;
          NOTE: Details of surgical procedures should be provided in Section A: Surgery

          _




BIACUC.protocol.2012-ver 1.3                                                                                                     Page 6
                       BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                 # 00-000




4.A.      Use of non-pharmaceutical grade drugs, substances or compounds
          Will all chemicals and substances used in animals be pharmaceutical grade? [ ] Yes           [ ] No
          If no, specify which are non-pharmaceutical grade, provide a scientific justification for the use of each, and provide the
          methods to be employed to unsure the sterility of the compound. Include as much information as possible about each
          substance (e.g. grade, purity, sterility, acid-base balance, pyrogenicity, osmolality, stability, side effects and adverse
          reactions, storage, pharmacokinetics).

          _
                                                                                                                  [return to table of contents]

5.        Experimental Manipulations

5.A.      Is surgery to be performed?         [ ] Yes [ ] No
          If yes, complete Section A: Surgery, Section C: Minimization of Pain and Discomfort, and, if the surgery is survivable, provide
          an appropriate Pain & Distress Rating Scale (See Section I)

5.B.      Are anesthetics to be administered?               [ ] Yes [ ] No   If yes, complete Section B: Anesthesia

5.C.      Will animals have or experience any of the following: [ ] Yes [ ] No
                      A serious or experimentally induced disease or condition, which may also include genetically modified
                         animals of phenotypic consequences are expected to interfere with the animals’ health and comfort;
                              More than momentary pain and discomfort [procedures that would be expected to cause pain or distress in
                               a human should also be considered painful to animals (antibody production studies included)];
                              Food or water withheld;
                              Prolonged restraint [prolonged restraint means the animal is kept confined or immobilized for time periods
                               in excess of those required for administration of treatments or routine handling procedures];
                              Subjected to aversive stimuli?
                  If yes, complete Section C: Minimization of Pain and Discomfort, Section D: Experimentally Induced Disease or
                  Condition, and provide an appropriate Pain & Distress Rating Scale (See Section I).


5.D.      Do the activities described in this protocol require the use of hazardous materials, including biological materials, chemicals,
          and/or radioactive substances?        [ ] Yes [ ] No If yes, complete Section F: Hazardous Substances

                                                                                                                  [return to table of contents]




6.        Animal Disposition How will animals be disposed? Check [x]all that apply.
              [ ] Adoption: See policy on Disposition of Animals
              [ ] Euthanasia (complete Section E: Euthanasia below)
              [ ] Return to colony
              [ ] Return to wild
              [ ] Transfer to different project. Protocol(s) #
              [ ] Death is to be an endpoint. Provide scientific justification: _

              [ ] Other (Please explain): _


BIACUC.protocol.2012-ver 1.3                                                                                                        Page 7
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



          NOTE: The Institutional Biosafety Committee (IBC) policy prohibits the donation of animal carcasses to outside entities. For
          more information on this policy see: http://www.researchadmin.iu.edu/Biosafety/IUB/bio_home.html

7.        Assurance That Proposed Work Does Not Unnecessarily Duplicate Previous Research
          Does the animal use described in this protocol unnecessarily duplicate previous research or teaching?

          [ ] Yes [ ] No

          If yes, please explain: _



8.        Teaching Proposals. Complete only If this project requires the use of live animals in teaching exercises.

8.A.      Will students be informed of the use of live animals in the course prior to the end of the first week of classes?

          [ ] Yes [ ] No

8.B.      Will alternative exercises be available for students who object to the use of live animals?

          [ ] Yes [ ] No

          If yes, describe the alternatives: _

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 8
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                              # 00-000



ADDITIONAL SECTIONS – Check [X] each additional section(s) you are completing with this protocol application.

     [ ] Section A: Surgery – complete if you are proposing either survival or non-survival surgeries.

     [ ] Section B: Anesthesia – complete if you will use anesthesia or analgesia, even if it is for non-surgical procedures

     [ ] Section C: Minimization of Pain and Discomfort – complete if any procedure causes more that slight or momentary
         discomfort or pain.

     [ ] Section D: Experimentally Induced Disease or Condition

     [ ] Section E: Euthanasia – complete if you will be euthanizing any animals

     [ ] Section F: Hazardous Substances – complete if the proposed study uses any hazardous substances. biological agents,
         genetically modified animals, chemical, radioactive, or other hazardous substances

     [ ] Section G: Breeding, Ordering, or Using Pregnant Animals – complete if you are ordering pregnant females, OR if you are
         breeding animals under this protocol

     [ ] Section H: Standard Operating Procedure (SOP) for Investigator Maintained Animals – complete if your animals will not be
         maintained by LAR staff

     [ ] Section I: Pain & Distress Rating Scale Template – If you checked Sections A (survival surgeries only), C, or D above,
         complete this section. Alter as appropriate for your species and/or procedures

     [X] Section P: Project Personnel – Complete for ALL persons working with animals on this study




                                                                                                              [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                    Page 9
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



Section A :: Surgery

In compliance with federal regulations (the Animal Welfare Act and Public Health Service Policy), all survival surgery in vertebrate
animals must be performed using aseptic procedures, including surgical gloves, masks, sterile instruments and aseptic techniques.
Non-rodent mammalian survival surgery must be performed in an operating room used only for surgery. See the BIACUC surgery
policies

The proposed surgery will be (check [X] Acute/non-survival and/or Survival, as appropriate):

A.1.      [ ] Acute/non-survival: The animal will remain anesthetized during the entire procedure and will be euthanized without
          awakening. Provide the following information and complete Section B: Anesthesia and Section E: Euthanasia

A.1.a)    Location (building and room number) where surgery will be performed: _

A.1.b)    Describe animal preparation, operative site preparation, and description of procedures to be performed:
          _

A.1.c)    Describe the experimental endpoint:
          _

A.2.      [ ] Survival: The animal will awaken from anesthesia. Major survival surgery is defined by the Guide for the Care and Use
          of Laboratory Animals as penetrating and exposing a body cavity or producing substantial impairment of physical or
          physiological function. Provide the following information and complete Section B: Anesthesia, Section C: Minimization of
          Pain and Discomfort and Section I: Pain & Distress Rating Scale

A.2.a)    Location (Building and Room number) where surgery will be performed: _

A.2.b)    Describe the surgical procedures. Include pre-operative care of the animal, aseptic preparation of the animal, surgeon,
          instruments and operative site. Describe the location and size of incisions, size and placement of catheters or devices that
          will be implanted, suture types used:
          _

A.2.c)    Post-operative care provider(s): Who will be responsible for providing post-operative care?
          _

A.2.d)    Description of post-operative care: Include supportive care such as supplemental heat, administration of fluids or
          analgesics, how often animals will be observed and all drugs (except analgesics) to be administered following surgery.
          Specify frequency of observation and drug administration in terms of intervals (e.g. every 6 hours, NOT 4 times a day)
          _

A.2.e)    Clinical Outcomes: Describe the clinical signs and/or lesions that are normally expected in the animals as a result of the
          procedures (e.g., tumors, surgical wounds, weight loss, behavioral abnormalities, illness, etc.)
          _

A.2.f)    Post-operative complications: What post-operative complications are reasonably possible and how will they be resolved?
          (“none” is not a generally acceptable response)
          _

A.2.g)    Multiple procedures: If more than one major survival surgical procedure (MMSS) will be done on any animal, explain and
          justify why multiple procedures must be performed:
          _

                                                                                                             [return to Additional Sections]

                                                                                                                [return to table of contents]


BIACUC.protocol.2012-ver 1.3                                                                                                      Page 10
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                              # 00-000



Section B :: Anesthesia and Analgesia

Complete this section if anesthesia or analgesia is to be administered. Procedures that cause more than momentary or slight pain or
distress to the animal must be performed with appropriate sedation, analgesia or anesthesia. The regime should be constructed in
consultation with an IU veterinarian. Procedures to be conducted without appropriate anesthesia must be scientifically justified.

B.1.      Pre-operative regimen: Include length of withholding of food and/or water and pre-anesthetic drugs administered.
          Include dosage and routes of administration.

          _

B.2.      Anesthetic regimen: Provide a listing of all induction, maintenance, and muscle relaxant drugs, including dosages and
          routes of administration.

          _

B.3.      Analgesic drugs: Provide the drug name(s), dosage(s), routes and frequency of administration. If analgesic drugs cannot be
          administered, provide scientific justification for withholding them.

          _

B.4.      Procedures and methods: Describe procedures that will be used to indicate that adequate depth of anesthesia is being
          maintained. Include the frequency of monitoring the animal, the criteria that will be used to determine that administration
          of additional anesthetic agent is required, and how records of the anesthetic procedures are kept.

          _

B.5.      Gases: if volatile gases, such as isoflurane, are to be used describe the scavenging technique.

          _

                                                                                                            [return to Additional Sections]

                                                                                                              [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                    Page 11
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



Section C :: Minimization of Pain and Discomfort

The Animal Welfare Regulations (AWA) require investigators to consider alternatives to procedures that may cause more than
momentary or slight pain or distress to the animals and to provide a written narrative of the methods used and sources consulted to
determine the availability of alternatives. For more information see USDA Policy #12

Alternatives or alternative methods are generally regarded as those that incorporate some aspect of replacement, reduction, or
refinement of animal use in pursuit of the minimization of animal pain and distress consistent with the goals of the research. These
include methods that
          refine animal use by lessening or eliminating pain or distress and, thereby, enhancing animal well-being;
          reduce the number of animals to the minimum required to obtain scientifically valid data;
          use non-animal systems or less sentient animal species to partially or fully replace animals (for example, the use of an
              in vitro or insect model to replace a mammalian model).
         Potential alternatives that do not allow the attainment of the goals of the research are, by definition, not alternatives
C.1.     REFINE. Please explain how you have refined procedures to be less painful or uncomfortable.
         _

C.2.      REDUCE. Please explain why you cannot further reduce the number of animals used.
          _

C.3.      REPLACE. Please explain why non-vertebrate species, different organisms, in vitro systems or computer simulation cannot be
          used.
          _

C.4.      Perform a literature search to determine if further alternatives [that reduce or refine the painful procedures in your
          protocol] exist. Please cite specific sources in the table below. You must consult at least two databases. IU Libraries provide
          access to multiple databases via One Search: http://www.libraries.iub.edu/index.php?pageId=1697&mode=subjectId
          The search strategy should include keywords that are relevant to the procedure(s) proposed and demonstrate a good faith
          effort to search for alternate methods. When developing your search strategy, consider the following sources for keywords
          and concepts related to this study:
             The objectives and endpoints of the proposed study
             Drugs and/or compounds to be administered to animals
             Proposed methods and procedures that may cause pain or distress to the animal
             Potential alternatives of which you are aware. (e.g., alternate experimental designs, modified techniques, housing
              modifications, modified restraint, in vitro methods, alternate models, etc.)
C.4.a)    Describe your search strategy: e.g. Keywords and concepts used; refinement of search.
          _
C.4.b)    Date of Search: _
C.4.c)    Years covered by search: _
C.4.d)    Databases consulted (at least two): _
C.5.      Describe the potential alternatives discovered in your search. If you are rejecting any of the alternatives, provide scientific
          justification for doing so.
          _

                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 12
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                              # 00-000



Section D :: Experimentally Induced Disease or Condition

A completed Pain & Distress Rating Scale (See Section I) must be completed and included with this protocol if the animals have a
        serious natural or experimentally induced condition.

D.1.      What condition(s) will the animals have? _

D.2.      Clinical Outcomes: Describe the clinical signs and/or lesions that are expected in the animals as a result of the disease or
          condition (e.g., tumors, surgical wounds, weight loss, behavioral abnormalities, illness).
          _

D.3.      How will progression of the condition be monitored? What are the criteria?
          _

D.4.      Endpoint Criteria: What are the specific objective criteria or endpoints for toxicity or euthanasia? Describe the criteria and
          the intervention used to prevent unnecessary pain and distress. Criteria are specific to each study and may include, but are
          not limited to:
                Weight loss beyond a predetermined limit
                Pain or distress not controlled by with analgesics
                Loss of normal movement
                Loss of normal feeding or drinking behavior
          Intervention may include, but is not limited to:
                Euthanasia
                Discontinuation of a procedure
                Removal from the the study
          _

D.5.      What measures will be taken to alleviate or minimize pain/distress? (Analgesics, or other manipulations)
          _

D.6.      If any methods/techniques listed below will be used, check the appropriate box and provide the requested details.

D.6.a)    [ ] Administration of a hazardous/toxic substance into a living animal: substance name, site, volume, frequency.
          _

D.6.b)    [ ] Immunization protocols: adjuvant(s) used, injection site & volume/site, frequency of immunization; method, frequency
          and volume of blood withdrawal (including anesthetic if used).
          _

D.6.c)    [ ] Prolonged restraint: Prolonged restraint means the animal is kept confined or immobilized for time periods in excess of
          those required for administration of treatments or routine handling procedures. Describe method, duration, frequency,
          adaptation of animal to restraint device.
          _

D.6.d)    [ ] Food/water deprivation: duration, frequency, extent (total/partial), methods that will be used to assess and monitor
          distress. Provide a copy of the template you will use to record daily written records for deprived animals.
          _

D.6.e)    [ ] Abnormal environment: temperature, humidity, light, duration, bedding changes.


BIACUC.protocol.2012-ver 1.3                                                                                                    Page 13
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                              # 00-000



          _

D.6.f)    [ ] Hybridoma protocols: priming agent, cells injected, schedule for collection of ascites, number of abdominal taps, size of
          needle used.
          _

D.6.g)    [ ] Adverse stimuli: type and intensity of stimulus, duration, justification for use.
          _

D.6.h)    [ ] Tumor induction
          _

                                                                                                            [return to Additional Sections]

                                                                                                              [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                    Page 14
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                              # 00-000



Section E :: Euthanasia

Consistent with AVMA Guidelines on Euthanasia, the BIACUC requires that, following euthanasia by CO2, death be confirmed through
physical means such as the creation of a bilateral pneumothorax, decapitation, or cervical dislocation. Any exception to this
requirement must be scientifically justified and approved by the BIACUC.

E.1.      Chemical Method – check[X] all that apply

          [ ] Lethal injection using a commercial or laboratory prepared euthanasia solution at the recommended dosage (Socumb,
              Euthasol, Beuthanasia-D). Specify name, dose, and route of administration.
              _

          [ ] Inhalation of anesthetic gases. Please specify. _
              For inhalation of anesthetic gases, what scavenging technique will be used?
                   [ ] Charcoal filter
                   [ ] Fume hood
                   [ ] Snorkel system
                   [ ] Other. Please specify. _

          [ ] Inhalation of carbon dioxide (rodents, amphibians, birds). Check physical method of assurance below.

          [ ] Inhalation of carbon dioxide administered by LAR staff according to the LAR SOP

E.1.a)    If euthanasia is to be induced by a chemical method without the use of a physical means of assurance, describe how death
          will be assured.

E.2.      Physical Method - check[X] all that apply

          [ ] Cervical dislocation

          [ ] Decapitation

          [ ] Bilateral pneumothorax

          [ ] Perfusion/exsanguinations

          [ ] Other:

E.2.a)    If the euthanasia is to be induced by a physical method without the use of anesthetics or sedatives, provide scientific
          justification:
          _



                                                                                                            [return to Additional Sections]

                                                                                                              [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                    Page 15
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



SECTION F :: HAZARDOUS SUBSTANCES

Complete this section only if the project requires the use of any of the following agents in live animals, or if any of the agents may
pre-exist in the species you are using. Check all agents that apply and identify the agent. Include dose, route, and frequency for
treatment, post-mortem handling of animals or tissue, and any other exposure scenario for personnel.

F.1.      Use of the following agents requires review by the institutional biosafety committee (IBC) and or the biosafety office.
          Contact the Biosafety Office at biosafe@indiana.edu for information. See also
          http://researchadmin.iu.edu/Biosafety/IUB/bio_home.html. Check [X] and identify if you are using any:

          [   ] Biological toxin: _
          [   ] Infectious agent: _
          [   ] Recombinant DNA: _
          [   ] Transplantable cell line: _

F.1.a)    Level of review – check [X] all that apply
          [ ] BL1
          [ ] BL2
          [ ] BL3
          [ ] Not yet determined

F.2.      Use of the following requires Radiation Safety Training. Contact the Radiation Safety Officer at 855-3230.

          [ ] Radioisotopes: _

F.3.      Use of the following agents requires Chemical Safety Training. Contact EH&S 855-6311 for assistance or see
          http://www.ehs.indiana.edu/lab_safety.shtml. - check[X]and identify all that apply
          [ ] Carcinogens: _
          [ ] Controlled substances, prescription drugs, or intoxicants: _
          [ ] Novel substances: _
          [ ] Reproductive hazards: _
          [ ] Toxic chemicals: _

F.4.      What precautions will be taken to protect personnel involved in the protocol? (Describe personal protective equipment)
          _

F.5.      Describe any special waste and animal disposal requirements (carcinogen, biohazard, radiation, etc.)
          _


                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 16
                       BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                               # 00-000



SECTION G :: BREEDING, ORDERING, OR USING PREGNANT ANIMALS
If more than one species/strain is to be bred for this study, complete a separate Section G for each species/strain. If the animals for
this study are bred under another protocol, then do not complete this section.
G.1.      Species _                    Strain _
G.1.a)    For genetically altered animals, include the gene altered: _
G.1.b)    Are all housing and handling practices standard?       [ ] Yes [ ] No
          If no, describe all deviations from standard procedures and practices. _
G.2.      Purpose
G.2.a)    Will animals be bred specifically for this study?      [ ] Yes [ ] No
G.2.b)    If yes, describe the reasons below. Could these animals be purchased from a commercial vendor? Complete Sections 2 and
          3 below. _
          If you will be purchasing pregnant animals, will offspring be produced?           [ ] Yes [ ] No
           If yes, continue to section 3 below. If no, Section G is complete
G.3       Breeding
G.3.a)    Source of breeding stock _
G.3.b)    Number of breeding animals that will be held, but not subject to experimental manipulations:
          # males: _
          # females: _
          Total number: _
G.3.c)    Mating scheme
          Continuous - If continuous, how many months or years will the females be bred? _
          Interrupted - If interrupted, how frequently will the females be bred: _
          Maximum number of litters/births before retiring females: _
          Disposition of retired breeders (males and females). _
          If euthanasia, please state method: _
G.3.d)    Briefly describe colony management. Include methods of tracking the number of births and disposition:
          _
G.4.      Offspring Produced and Disposition
G.4.a)    For rodents, at what age, or range of ages, will weaning occur? _
G.4.b)    Estimate the number of animals produced that will be subject to experimental manipulations: _
G.4.c)    Estimate the number of offspring produced by this colony that will be euthanized, and will not be subject to experimental
          manipulations: _
G.4.d)    Explain the how this number (G.4.c)) was determined and justify. Include culling for sex selection or to achieve
          standardized litter size: _
G.4.e)    Approximate total number of offspring produced (sum of G.4.b)and G.4.c), above): _
                                                                                                              [return to Additional Sections]
                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 17
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                               # 00-000



SECTION H :: STANDARD OPERATING PROCEDURES FOR INVESTIGATOR-MAINTAINED ANIMALS

** Animals must be observed daily (365 days a year) including weekends and holidays **

H.1.      Person(s) Responsible for Providing Animal Care: _

H.2.      Room Number(s)/Building Name: _

H.3.      Other Activities Conducted in This Room: _

H.4.      Species (List All or Provide Separate SOP for Each): _

H.5.      What type of tank, tub, or cage ("primary enclosure") is used for housing?

H.5.a)    Materials and construction: _

H.5.b)    Size of enclosure and maximum number of animals per enclosure: _

H.5.c)    How are feed and water provided within each (bowls, on floor, special devices, etc.)? _

H.6.      What methods if any are used to provide or monitor essential levels of the following environmental parameters? _

H.6.a)    Temperature? _
H.6.b)    Humidity? _
H.6.c)    Ventilation? _
H.6.d)    Illumination? _
H.6.d)    Noise? _
H.6.f)    Tank water quality? _
H.7.      Behavioral Management

H.7.a)    Structural environment: What structural features (e.g., for resting, climbing, perching, hiding) if any are added to
          enclosures? _

H.7.b)    Social housing: Are animals housed singly or in groups; how are social groups maintained? _

H.7.c)    Activity: Are animals provided any means of activity outside of enclosure? _

H.8.      Food
H.8.a)    Type and Source (Vendor and Manufacturer if different) _

H.8.b)    Storage: Room number, refrigerated or frozen storage, type of feed container _
Note: Feed must be stored in a covered or sealed container separate from carcasses, tissues or chemicals used for research or
        cleaning. Containers should be labeled with contents, milling/manufacture date or expiration date if applicable.

H.8.c)    Food Preparation: How and where (room # if different from housing area) is food prepared if applicable? _

H.8.d)    If live feed is provided, how is it maintained or fortified with additional nutrients? _

H.8.e)    How Is Food Provided (Frequency, quantity per animal or ad libitum)? _

H.8.f)    Quality Control: How long are feed or supplements maintained? _

H.8.g)    What other methods are used to insure adequacy of nutrients? _

H.9.      Drinking Water - Source, Treatment and How Provided (Tank water for aquatic species should be described in Section
          H.5.)

H.9.a)    Municipal (tap), well, other? _

BIACUC.protocol.2012-ver 1.3                                                                                                     Page 18
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                            # 00-000



H.9.b)    Filtered, chemically treated, autoclaved, testing performed, other? _

H.9.c)    Bottles, bowls, automatic watering system, other? _

H.9.d)    Frequency for replacing drinking water: _

H.10.     What type of bedding or substrate, if any, is used?

          _


H.10.a) How often is it replaced? _

H.10.b) Where is it? _

H.11.     Sanitation

H.11.a) How often is tank water changed and approximately what percentage of water is changed each time? _

H.11.b) Where is soiled bedding or substrate removed? _

H.11.c) How often is the primary enclosure (tank, tub, cage or, if animals are loose in room, entire room) cleaned (as described in
        section d. below)? _

H.11.d) Primary Enclosure Sanitation

H.11.d)(i)     Where are enclosures and caging accessories washed? _

H.11.d)(ii)    Hand washing, mechanical/machine washing, or autoclave usage? _

H.11.d)(iii)   Duration of exposure to sanitizing/disinfecting agent? _

H.11.d)(iv)    Is hot water or steam employed for sanitation? If so, provide temperature if measured: _

H.11.d)(v)     Other procedures designed to assure removal of gross soils, disinfection of surfaces, and adequate removal of
               sanitizing chemicals? _

H.11.d)(vi) Cleaning/Sanitizing Agents Used: _

H.11.e) Cleaning and Disinfection of Secondary Enclosures (Room or Area Where Tanks or Cages are Held)

H.11.e)(i)     Animal Room Cleaning Frequency _

H.11.e)(ii)    Procedures or Methods (Equipment Used) _

H.11.e)(iii)   Sanitizing Agents _

H.11.e)(iv)    Support Area Cleaning _

H.11.e)(v)     Sanitation of Caging Accessories _

H.11.e)(vi)    Procedures and Frequency for Cleaning Feeders and Watering Devices _

H.11.e)(vii) Procedures and Frequency for Enrichment Devices or Other Structural Additions to Enclosures _

H.11.e)(viii) Soiled Bedding and Refuse: How is this handled and discarded? _

H.12.     Waste disposal

H.12.a) How are animal carcasses stored or discarded? (i.e. Frozen in sealed bags and request EH&S pick-up at
        www.ehs.indiana.edu “Request Assistance” or other method) _




BIACUC.protocol.2012-ver 1.3                                                                                                   Page 19
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                            # 00-000



H.12.b) Hazardous (and Non-Hazardous) Chemical, Radioactive, and Biological Agents, Waste, and Sharps Disposal (Call EH&S for
        guidance 855-6311) including Packaging, Labeling, Disinfection (i.e. autoclave, chemical disinfection, etc.), Storage, and
        Separation from Animals or Feed, Disposal: _

H.13.     Pest Control – describe vermin control program

          _


H.14.     How Is Emergency, Weekend, and Holiday Care Provided?

          _


H.15.     Identification and Records

          _


H.15.a) Methods for Identification of Each Species _

H.15.b) What individual or group records do you maintain for identifying animals and their sources or pedigrees? _

H.16.     Breeding Colony Maintenance

H.16.a) What, if any, species, stocks or strains do you produce in-house? _

H.16.b) Describe the breeding scheme used to assure homozygosity of inbred lines or heterozygosity of outbred lines if applicable.
        _

H.16.c) Do you do any genetic monitoring? If so, what do you test for and how? _

H.17.     Security

H.17.a) Who has access to room(s) where animals are maintained? _

H.17.b) How is area secured? _

H.17.c) How do you assure that only authorized people have access to animals under your care? _
                                                                                                          [return to Additional Sections]

                                                                                                            [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                  Page 20
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                       # 00-000



                                      Pain & Distress Rating Scale and Long-Term Post Surgery Monitoring for Non-USDA Regulated Rodent

     Animal is to be assessed with the determined pain score documented, at least every morning for a period no less than14 days post procedure unless the animal has a total
                                                                       score of 0 for 5 consecutive days.


        Assessment Category                AssessmentScore = 0                    AssessmentScore = 1                         AssessmentScore = 2                     AssessmentScore = 3
                                                                             Less active, moves around cage              Will not move around cage when
       Attitude and Movement           Alert, freely moves about cage                                                                                                    Lying on side
                                                                                  only when stimulated                              stimulated
          Coat and Posture               Smooth coat, not hunched                 Hunched or ruffled fur                    Hunched with ruffled fur
                                                                                                               Moderate* swelling and/or redness
                                                                              Clear discharge or redness or                                           Surgical site open exposing underlying
                                                                                                              and pus and/or persistent scratching
             Surgical Site                 Clean and not swollen              mild* swelling or occasional                                               subcutaneous tissues or intra-
                                                                                                                 at surgical site and/or pressing
                                                                                scratching at surgical site                                                       abdominal cavity
                                                                                                              surgical site to side or bottom of cage
                                                                            Weight decreased by ≤10% compared    Weight decreased >10%, <20%,         Weight decreased by ≥20% compared
               Appetite                 Eating and drinking normally
                                                                                   to pre-surgical weight       compared to pre-surgical weight               to pre-surgical weight
                                                                                                                                                               Respiratory distress or open mouth
           Respiratory Rate                    Breathing normally                Increased respiratory rate                Labored or difficulty breathing
                                                                                                                                                                           breathing
___________
Treatment Plan (in consultation with Attending Veterinarian)
 Scores = 3 in any category: euthanize immediately
 Scores = 2 in any category: consult with vet
 Score = 2 for Surgical Site: Pradminister analgesic )Metacam 1mg/kg s.c. or Rimadyl 5 mg/kg s.c.) & consult with vet
 Score > 1 in Appetite: Provide easy access to food- moist crushed feed in petri dish
 Animals will be weighed daily for 14 days; the Attending Veterinarian will be consulted if any weight loss exceeds 10% of the pre-surgical weight

*Mild swelling: skin around incision raised but no increased tension on sutures;
 Moderate swelling: skin around incision raised causing skin tension around sutures or separation of incision

        Protocol #:                                                                               Animal ID:
      TIME & DATE         POSTURE   MOVEMENT     SURGICAL SITE   APPETITE    ELIMINATION   TOTAL SCORE        INITIALS                                       ACTION
1.

2.

3.




BIACUC.protocol.2012-ver 1.3                                                                                                              Page 21
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                           # 00-000



        Protocol #:                                                                           Animal ID:
      TIME & DATE         POSTURE   MOVEMENT   SURGICAL SITE   APPETITE   ELIMINATION   TOTAL SCORE   INITIALS                        ACTION
4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.



Date surgery site healed: Incision is closed, no redness associated with wound, and no scabbing is present
________________________________________________________




BIACUC.protocol.2012-ver 1.3                                                                                                Page 22
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



SECTION P :: PROJECT PERSONNEL: EXPERIENCE AND TRAINING DOCUMENTATION
Please read the statements below and check [X] the boxes beside them to indicate that you understand and agree to comply with
the following:
     [ ] I UNDERSTAND THAT NO PERSON LISTED ON THIS AMENDMENT MAY BEGIN WORKING WITH ANIMALS UNTIL THIS PROTOCOL HAS BEEN APPROVED
         BY THE BIACUC, AND A SIGNED COPY OF THE APPROVED PROTOCOL HAS BEEN SENT TO THE PI BY THE BIACUC ADMINISTRATOR.

     [ ] I FURTHER UNDERSTAND THAT FAILURE TO COMPLY WITH THE ABOVE STATEMENT IS A SERIOUS PROTOCOL VIOLATION THAT IS REPORTABLE TO THE
         INSTITUTIONAL OFFICIAL, NIH, AND THE USDA.
     [ ] I ASSURE THAT ALL PERSONNEL LISTED BELOW AND ON THE FOLLOWING PAGES HAVE COMPLETED IACUC TRAINING AND PASSED THE REQUIRED
         BIACUC TESTS, INCLUDING THE OCCUPATIONAL HEALTH AND SAFETY FOR PERSONNEL WORKING WITH ANIMALS. I FURTHER ASSURE THAT ALL
         PERSONNEL HAVE COMPLETED THE OCCUPATIONAL HEALTH AND SAFETY MEDICAL SURVEILLANCE FORM AND HAVE BEEN CLEARED BY AN IU
         HEALTH DOCTOR TO WORK WITH ANIMALS. HTTP://WWW.RESEARCHADMIN.IU.EDU/IACUC/IUB/BIACUC_EDUCATION.HTML
INSTRUCTIONS: List ALL personnel working with animals on this study (co-investigators, postdoctoral fellows, students, research
assistants, and technicians). The following information is required for each individual:
PI : _

Responsibilities Check [X] all that apply.
     [   ]    Anesthesia                [ ] Injections                 [ ] Surgery – survival
     [   ]    Animal Handling           [ ] Perfusion                  [ ] Surgery – non-survival
     [   ]    Euthanasia                [ ] Peri- or post-operative monitoring
     [   ]    Additional Responsibilities _

Experience What is this individual’s previous training and experience using animals, and with what species? What procedures has the
individual performed? If the personnel are experienced at the tasks they will be performing, how long have they been doing it?
Where and by who were they trained?
_

Training If the individual lacks experience with the procedures they will ultimately perform, who will train him or her? What are the
qualifications of the trainer? How will it be determined when, or if, this individual is qualified to work unsupervised? (Includes animal,
chemical, radiological, and/or biosafety as applicable)
_

BIACUC-CITI courses: http://researchadmin.iu.edu/EO/eo_citi.html. Check [X] all that have been completed.
     [   ]   Investigators, Staff and Students, Basic Course (required)    [ ] Working with Mice
     [   ]   Working with Rats                                             [ ] Working with Rabbits
     [   ]   Working with Dogs                                             [ ] Working with Amphibians
     [   ]   Working with Hamsters
     [   ]   Occupational Health and Safety Training for Personnel Working with Animals (required)

Training by Laboratory Animal Resources Personnel:
     [ ] Aseptic surgery (required prior to participating in any surgical procedures)

Medical Clearance to Work with animals: https://www.bloomingtonhospital.org/oth/Page.asp?PageID=OTH001339
   [ ] Medical Surveillance Questionnaire and follow-up (required)

Chemical Safety Training: see http://www.ehs.indiana.edu/lab_safety_training.shtml
   [ ] Laboratory Safety and Chemical Hygiene Training

                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]

BIACUC.protocol.2012-ver 1.3                                                                                                      Page 23
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



Name : _                                                        Network ID: _
Position : _                                                    Dept/Program: _
Responsibilities Check [X] all that apply.
    [ ] Anesthesia                   [ ] Injections                  [ ] Surgery – survival
    [ ] Animal Handling              [ ] Perfusion                   [ ] Surgery – non-survival
    [ ] Euthanasia                   [ ] Peri- or post-operative monitoring
    [ ] Additional Responsibilities _

Experience What is this individual’s previous training and experience using animals, and with what species? What procedures has the
individual performed? If the personnel are experienced at the tasks they will be performing, how long have they been doing it?
Where and by who were they trained?
_

Training If the individual lacks experience with the procedures they will ultimately perform, who will train him or her? What are the
qualifications of the trainer? How will it be determined when, or if, this individual is qualified to work unsupervised? (Includes animal,
chemical, radiological, and/or biosafety as applicable)
_

BIACUC-CITI courses: http://researchadmin.iu.edu/EO/eo_citi.html. Check [X] all that have been completed.
     [   ]   Investigators, Staff and Students, Basic Course (required)    [ ] Working with Mice
     [   ]   Working with Rats                                             [ ] Working with Rabbits
     [   ]   Working with Dogs                                             [ ] Working with Amphibians
     [   ]   Working with Hamsters
     [   ]   Occupational Health and Safety Training for Personnel Working with Animals (required)

Training by Laboratory Animal Resources Personnel:
     [ ] Aseptic surgery

Medical Clearance to Work with animals: https://www.bloomingtonhospital.org/oth/Page.asp?PageID=OTH001339
   [ ] Medical Surveillance Questionnaire (required) and follow-up

Chemical Safety Training: see http://www.ehs.indiana.edu/lab_safety_training.shtml
   [ ] Laboratory Safety and Chemical Hygiene Training

                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 24
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



Name : _                                                        Network ID: _
Position : _                                                    Dept/Program: _
Responsibilities Check [X] all that apply.
    [ ] Anesthesia                   [ ] Injections                  [ ] Surgery – survival
    [ ] Animal Handling              [ ] Perfusion                   [ ] Surgery – non-survival
    [ ] Euthanasia                   [ ] Peri- or post-operative monitoring
    [ ] Additional Responsibilities _

Experience What is this individual’s previous training and experience using animals, and with what species? What procedures has the
individual performed? If the personnel are experienced at the tasks they will be performing, how long have they been doing it?
Where and by who were they trained?
_

Training If the individual lacks experience with the procedures they will ultimately perform, who will train him or her? What are the
qualifications of the trainer? How will it be determined when, or if, this individual is qualified to work unsupervised? (Includes animal,
chemical, radiological, and/or biosafety as applicable)
_

BIACUC-CITI courses: http://researchadmin.iu.edu/EO/eo_citi.html. Check [X] all that have been completed.
     [   ]   Investigators, Staff and Students, Basic Course (required)    [ ] Working with Mice
     [   ]   Working with Rats                                             [ ] Working with Rabbits
     [   ]   Working with Dogs                                             [ ] Working with Amphibians
     [   ]   Working with Hamsters
     [   ]   Occupational Health and Safety Training for Personnel Working with Animals (required)

Training by Laboratory Animal Resources Personnel:
     [ ] Aseptic surgery

Medical Clearance to Work with animals: https://www.bloomingtonhospital.org/oth/Page.asp?PageID=OTH001339
   [ ] Medical Surveillance Questionnaire (required) and follow-up

Chemical Safety Training: see http://www.ehs.indiana.edu/lab_safety_training.shtml
   [ ] Laboratory Safety and Chemical Hygiene Training

                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 25
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



Name : _                                                        Network ID: _
Position : _                                                    Dept/Program: _
Responsibilities Check [X] all that apply.
    [ ] Anesthesia                   [ ] Injections                  [ ] Surgery – survival
    [ ] Animal Handling              [ ] Perfusion                   [ ] Surgery – non-survival
    [ ] Euthanasia                   [ ] Peri- or post-operative monitoring
    [ ] Additional Responsibilities _

Experience What is this individual’s previous training and experience using animals, and with what species? What procedures has the
individual performed? If the personnel are experienced at the tasks they will be performing, how long have they been doing it?
Where and by who were they trained?
_

Training If the individual lacks experience with the procedures they will ultimately perform, who will train him or her? What are the
qualifications of the trainer? How will it be determined when, or if, this individual is qualified to work unsupervised? (Includes animal,
chemical, radiological, and/or biosafety as applicable)
_

BIACUC-CITI courses: http://researchadmin.iu.edu/EO/eo_citi.html. Check [X] all that have been completed.
     [   ]   Investigators, Staff and Students, Basic Course (required)    [ ] Working with Mice
     [   ]   Working with Rats                                             [ ] Working with Rabbits
     [   ]   Working with Dogs                                             [ ] Working with Amphibians
     [   ]   Working with Hamsters
     [   ]   Occupational Health and Safety Training for Personnel Working with Animals (required)

Training by Laboratory Animal Resources Personnel:
     [ ] Aseptic surgery

Medical Clearance to Work with animals: https://www.bloomingtonhospital.org/oth/Page.asp?PageID=OTH001339
   [ ] Medical Surveillance Questionnaire (required) and follow-up

Chemical Safety Training: see http://www.ehs.indiana.edu/lab_safety_training.shtml
   [ ] Laboratory Safety and Chemical Hygiene Training

                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 26
                      BLOOMINGTON INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (BIACUC)                                # 00-000



Name : _                                                        Network ID: _
Position : _                                                    Dept/Program: _
Responsibilities Check [X] all that apply.
    [ ] Anesthesia                   [ ] Injections                  [ ] Surgery – survival
    [ ] Animal Handling              [ ] Perfusion                   [ ] Surgery – non-survival
    [ ] Euthanasia                   [ ] Peri- or post-operative monitoring
    [ ] Additional Responsibilities _

Experience What is this individual’s previous training and experience using animals, and with what species? What procedures has the
individual performed? If the personnel are experienced at the tasks they will be performing, how long have they been doing it?
Where and by who were they trained?
_

Training If the individual lacks experience with the procedures they will ultimately perform, who will train him or her? What are the
qualifications of the trainer? How will it be determined when, or if, this individual is qualified to work unsupervised? (Includes animal,
chemical, radiological, and/or biosafety as applicable)
_

BIACUC-CITI courses: http://researchadmin.iu.edu/EO/eo_citi.html. Check [X] all that have been completed.
     [   ]   Investigators, Staff and Students, Basic Course (required)    [ ] Working with Mice
     [   ]   Working with Rats                                             [ ] Working with Rabbits
     [   ]   Working with Dogs                                             [ ] Working with Amphibians
     [   ]   Working with Hamsters
     [   ]   Occupational Health and Safety Training for Personnel Working with Animals (required)

Training by Laboratory Animal Resources Personnel:
     [ ] Aseptic surgery

Medical Clearance to Work with animals: https://www.bloomingtonhospital.org/oth/Page.asp?PageID=OTH001339
   [ ] Medical Surveillance Questionnaire (required) and follow-up

Chemical Safety Training: see http://www.ehs.indiana.edu/lab_safety_training.shtml
   [ ] Laboratory Safety and Chemical Hygiene Training

                                                                                                              [return to Additional Sections]

                                                                                                                [return to table of contents]




BIACUC.protocol.2012-ver 1.3                                                                                                      Page 27

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:10
posted:8/11/2012
language:
pages:27