UCDHSC RESEARCH FREEZER INVENTORY
General Data Preparer's name: Building/Floor: Department: PI: Inventory Date (MM/DD/YY) Inventory Data Sample Description Active or Archival samples Speedtype # used to produce sample (if known) Type of material (Human, Animal, Microbial, Other) Number of samples Sample commercially available? If YES, cost per sample Avg reagent cost per sample Additional materials Subtotal Contract/grant research start date (MM/DD/YY) Avg research hours per day Subtotal For Human materials lines 16 & 17 # of Subjects Subject fees For Animal materials lines 19-22 # of Research animals Research animal per diem Per diem days required Research Animal cost per Animal Estimated value Comments: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FREEZER UCDHSC Inventory ID Tag # Alarm- Y/N Alarm Type Lock box on plug? Contact number:
Human Animal Microbial Other
Yes No
Active Archival
GRAND TOTAL:
$0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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$0.00
$0.00
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$0.00
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ULT Freezer Inventory Instructions Purpose: The ULT Freezer Inventory is intended to be utilized as a tool to estimate and report the value of research freezer inventory. The inventory worksheet is designed to obtain an estimate of freezer contents, not an exact value. Any freezer loss would be evaulated based on the freezer contents at the date of loss. The information from the inventory will be used to identify the potential loss exposure campus-wide. General Data:
Building/Floor Department PI UCDHSC Inventory ID Tag # Alarm- Y/N Please indicate the name of the building and floor for the location of the freezer. Indicate the department responsible for the freezer samples. Indicate name(s) of the PI(s) who have samples in this freezer. Please identify the six digit tag number. Please indicate "Yes" or "No" to indicate if the freezer is equipped with an alarm. If the freezer is equipped with an alarm, please indicate whether the alarm is local, central, or the other type of alarm being used. Please indicate whether the freezer is equipped with a lockbox for the plug.
Alarm Type Lockbox on Plug? Y/N
Inventory Data: Please enter the information requested for each sample type by category
Sample description Active or Archival Speedtype Number of samples Sample commercially available? If YES, cost per sample Avg reagent cost per sample Please briefly identify the sample. Please indicate whether the samples are Active or Archival. Please indicate the PeopleSoft speedtype which funds the contract/grant. Please indicate the number of samples contained in the freezer by type of sample. Please indicate whether the sample is commercially available, "Yes" or "No" If the sample is commercially available, please indicate the cost per sample. Please indicate the average reagent cost applied to each sample. For example- two reagents were applied at a cost of $2.00 and $5.00 per reagent. The average reagent cost applied to the sample is $3.50. Please indicate the cost of additional materials required to bring the sample to point at which it was frozen, including glassware, chemicals, disposables, human subject special diet costs, etc. Do not include special diet requirements for research animals if already included in the research animal per diem rate. Please specify the date that the research contract/grant started in MM/DD/YY format. Please indicate the average research hours per day invested per indvidual preparing the samples. Please include work hours directly related to the preparation of samples, e.g. tissue collection, applying reagents, etc. For example- two PRA's collect tissue samples over a one week period for six hours a day. The research hours per day are 12.
Additional materials
Contract/grant research start date (MM/DD/YY) Research hours per day
# of Subjects Subject fees # of Research animals
STUDIES WITH HUMAN SUBJECTS ONLY- Please indicate the number of human subjects from which samples were obtained for the study. STUDIES WITH HUMAN SUBJECTS ONLY- If applicable, please indicate the amount of subject fees paid per subject as part of the contract/grant. STUDIES WITH ANIMAL SUBJECTS ONLY- Please indicate the number of research animals required to obtain the samples.
Research animal per diem Per diem days required
STUDIES WITH ANIMAL SUBJECTS ONLY- Please indicate the daily per diem rate per animal. STUDIES WITH ANIMAL SUBJECTS ONLY- Please indicate the number of days of required to reach tissue harvest. STUDIES WITH ANIMAL SUBJECTS ONLY- Please indicate the purchase cost per animal.
Research Animal cost per Animal