RODENT IMPORT FORM by Yearoveryear

VIEWS: 8 PAGES: 1

									                                                                        QUARANTINE LOG NUMBER                                     -_______

                                                                                                IMPORT #
  tel: (514) 398-8289
  fax: (514) 398-7283

                                          RODENT IMPORT FORM
1- McGILL INVESTIGATOR INFORMATION
INVESTIGATOR:                             CONTACT:                                              TELEPHONE # :

ACCOUNT #:                                E-MAIL:

DEPT:                                     PROTOCOL #:                                           FAX # :

INSTITUTION:                              DATE:



2- SENDING INSTITUTION’S INFORMATION

INSTITUTION NAME:

LOCATION – CITY, STATE/PROVINCE, COUNTRY:

NAME OF SENDING INVESTIGATOR :

                        NAME:                                                         NAME:

                        TELEPHONE:                                                    TELEPHONE:
FACILITY                                                               VIVARIUM
VETERINARIAN:                                                          CONTACT:
                        FAX:                                                          FAX:

                        E-MAIL:                                                       E-MAIL:




3- ANIMAL INFORMATION
How will the animals be used?                Acute or terminal study         Chronic or survival study          Breeding colony

Facility where animals will be housed?                                                  Room:

Specify any special handling needs:

                                                                                                  QUANTITY          ACTUAL QTY
      SEX           BACKGROUND STRAIN             LINE NAME                       AGE                                                INITIALS
                                                                                                 REQUESTED           RECEIVED

     Male

    Female

     Male

    Female




                                                 OFFICE USE ONLY
ARRIVAL DATE IN QUARANTINE:                                               DATE TRANSFERRED:
 (yy-mm-dd)                                                               (yy-mm-dd)

INVESTIGATOR CONTACTED:                  DATE:                            INITIALS:




Revised (yy-mm-dd): 08-03-18                           Page 1               NATIONAL AND INTERNATIONAL RODENT IMPORT FORM REV 2
Effective date (yy-mm-dd): 05.10.01

								
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