Institutional Animal Care and Use Committee

APPENDIX 2A – USE OF BIOHAZARDS,

RADIATION SOURCES,

OR HAZARDOUS CHEMICALS

Protocol #

IACUC USE ONLY

Protocol Number

Principal Investigator

Project Title

For Hazardous Chemicals

1.  Indicate degree of health risks to humans.

Low Moderate High

2.  What materials will be used?

Agent

Species

Route

Dose

Animal Location

3. Is this a hazardous chemical that has not been used, previously, at Princeton University?

Yes No

If yes, the Assistant Director of Laboratory Animal resource, animal facility manager and the Office of Environmental Health and Safety must be contacted; and training of the animal care staff and researchers in the hazards, containment requirements, and husbandry practices is required.

Enter date of training:

Biohazards

1.  List biohazard(s):

2.  This work will be performed at:

Animal Biosafety Level 1 Animal Biosafety Level 2

3.  Describe the risks posed by the agent to research personnel and husbandry staff. Include a description of the consequences of a significant exposure to this agent, such as self-inoculation or bite from an infected animal.

4.  Do personnel require any special immunizations to work with the infected animals?

Yes No

If yes, describe immunizations required.

5.  Describe the precautions that will be taken when administering the agent to the animal:

a.  Where will the procedures occur:

b.  Describe how the agent will be administered to the animal. Include a description of containment precautions and equipment ( list all safety equipment that will be used to prevent accidental exposure to the agent, including biosafety cabinets, safety needles and personal protective equipment to be used when administering the agent.

6.  Describe precautions that must be taken by animal husbandry staff to prevent exposure while the agent is shedding (address personal protective equipment, containment during cage changing, waste disposal practices):

7.  Do animal feces, urine, and soiled bedding require any special handling?

Yes No

If yes, for how long, and what precautions must be taken during this phase?

8. Will animals be removed from the animal facility? Yes No

If yes, please give detail:

a.  List all locations and briefly describe procedures performed in each location:

b.  Describe how animals will be transported. Please include measures to limit exposure to others in hallways. Also include route of transportation.

c.  Precautions that will be followed in non-housing facility ( include containment, personal protective equipment, disinfection practices):

9. Personnel: List all personnel who will work with the infectious agent and animals infected under this protocol.

Last Name / First Name

Others?

10.  Has the use of this material in animals been approved by the Institutional Biological Safety Committee?

Yes- Please attach the approval letter from the IBC

No- If no, an IBC Registration must be submitted. (IBC approval is a pre-requisite for IACUC approval. Approval must be given from both the IACUC and the IBC before the PI can begin the experiment.)

11. Is this a biohazard that has not been used, previously, at Princeton University?

Yes No

If yes, training of the animal care staff and researchers in the hazards, containment requirements, and husbandry practices is required.

Enter date of training:

Resources: See Work with Biohazards in Princeton University Laboratory Animal Research Facilities for guidance on containment precautions, waste disposal and precautions for safe transfer of infected animals.

For Radiation Sources

1. For radioisotopes, list the radioisotope and amount (in millicuries) to be used per administration per animal and attach a copy of the application as approved by the Radiation Safety Committee.

Radioisotope / Amount per administration per animal (mCi) / Authorization Number / Authorization Expiration Date

2.  For radiation-producing equipment:

Will your research use one of the following x-ray machines? Yes No

If yes, please check the applicable box.

Faxitron Model RX650 Cabinet X-Ray System (located in Room 423 Moffett Lab)

Faxitron Model MX20 Cabinet X-Ray System (located in the Carl Icahn Barrier Facility)

PXI XRAD320 X-Ray Irradiator (located in the Carl Icahn Animal Facility)

My research will use radiation-producing equipment that is not listed above.

Review the following notes regarding review of radiation use by the Radiation Safety Officer, radiation safety training, and the use of radiation monitoring badges.

·  If your research will involve irradiations using any radiation-producing equipment that is not listed above, you must contact EHS to arrange for the Radiation Safety Officer to review the radiation use. The RSO will provide a memo approving the work or listing any conditions imposed on your research. Attach a copy of the RSO’s memo to this IUCAC application.

·  Any persons who plan to operate the Faxitron x-ray units must contact EHS to arrange for x-ray safety training and radiation monitoring badge service.

·  Irradiations using the PXI XRAD320 Irradiator are performed by LAR staff, so x-ray safety training and monitoring badge service are not required.

2

Revised 8/2013