ACORP App. 8 Last Name of PI►

Protocol No. Assigned by the IACUC►

Official Date of Approval►

ACORP Appendix 8

Use of Explosive Agent(s) within the VMU or in Animals

Version 4

See ACORP App. 8 Instructions, for more detailed explanations of the information requested.

1.  Full name(s) of Principal Investigator(s) ►

2.  Explosive agents to be used.

a.  Identify the explosive agents. Complete the table below.

Agent Number / Name(s) Used to Refer to the Agent in This ACORP / Name Shown for this Agent on the MSDS on File / CAS number / Location of the MSDS on File
1
2
3
4

b.  Locations where the explosive agents will be used. Complete the table below.

Agent Number / Location Where Agent Will Be Used
Building / Room Number / Within the VMU / Outside of VMU
1 / ( ) / ( )
2 / ( ) / ( )
3 / ( ) / ( )
4 / ( ) / ( )

c.  Procedure(s) to be performed. Briefly describe the use of each of the explosive agents on this protocol and explain why it is necessary to use these agents (why non-explosive replacements cannot be used instead).

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d.  Precautions to be taken to prevent explosions. Describe the measures to be taken to store, use, and dispose of safely each explosive agent and any materials contaminated with it, and to prevent the generation of sparks in its presence. See ACORP App. 8 Instructions, for a list of commonly used precautions.

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e.  Period of use.

Beginning no earlier than (date) ►

Ending no later than (date) ►

f.  Animals that will be administered explosive agents:

Species ►

Approximate weights of individual animals ►

Approximate number of animals ►

3.  Personnel. Complete the table below for each individual who will handle any of the explosive agents as part of this protocol.

Name of Individual / Explosive Agent(s) to be Handled / Training and Experience Pertinent to Handling Explosive Agents

4.  Signatures. Provide the signatures required on the signature pages (Item Z.8) of the main body of this ACORP.

1