Animal Use Protocol – Hazardous Agent Addendum (Pathogenic Organisms)

IACUC # ______

  1. Identify the pathogenic organismto be administered: Click here to enter text.
  2. Briefly describe purpose: Click here to enter text.
  3. Specify the amount administered (e.g., dose, concentration, volume): Click here to enter text.
  4. Indicate the route of administration (include range of needle gauge if applicable): Click here to enter text.
  5. Indicate the frequency of administration: Click here to enter text.
  6. Indicate the maximum duration of exposure: Click here to enter text.
  7. Identify the location (Building / Room) where the pathogenic organismwill be administered: Click here to enter text.
  8. Discuss any special husbandry requirements(e.g., singly housed animals). Click here to enter text.
  1. Describe the predicted effects of the pathogenic organism on the animal.
  1. Identify the known routes for excretion or shedding of the pathogenic organism.
  1. Describe the safety procedures and personnel protective equipment research staff will use while administering this organism and while handling animals and animal bedding.
  2. Specify the Animal Biosafety Level (ABSL) requirementwhile administering this organism and while handling animals and animal bedding.

☐ Level 1 ☐ Level 2 ☐ Level 3

  1. Will research staff administerthe pathogenic organism in a biosafety cabinet?

☐Yes ☐No

  1. Which pieces of personal protective equipment will be required for administration and handling of infected animals?

☐ Gloves

☐ Dust mask (used for protection against animal dander, not the infectious agent)

☐ N95 respirator (enrollment in EHS fit testing program required)

☐ Face Shield

☐ Protective laboratory eyewear

☐ Shoe Covers

☐ Laboratory coat, gown or uniform

☐ ABSL3 PPE as specified by the facility (e.g. PAPR, etc.)

☐ Additional PPE, please specify: Click here to enter text.

  1. Use this space to clarify any additional safety precautions used by research staffwhile administering this organism and while handling animals and animal bedding.

Click here to enter text.

  1. Discuss the length of time the animals will be kept following exposure to the pathogenic organism. Click here to enter text.
  1. Animal Housing:
  2. Following exposure, does the animal or its bedding pose a hazard to other animals, staff or the environment? ☐ Yes ☐ No

If yes, explain your answer. Click here to enter text.

  1. Specify the Animal Biosafety Level (ABSL) requirement for animal housing post-exposure.

☐ Level 1 ☐ Level 2 ☐ Level 3

  1. Identify location(s) of animal housing post-exposure: Click here to enter text.
  1. Will animals be returned to / housed in the animal facility following exposure? ☐ Yes ☐ No

If no, stop here. If yes, answer questions a & b below.

  1. Consult the Veterinary Resources Facilities Manager (r 410-960-2723) or the Deputy Director (r 443-677-9030)to review this form, answer item b (below) and discuss proper cage level documentation and cage handling procedures.

Date of consult: Click or tap to enter a date.

  1. Please list precautions and safety procedures Veterinary Resources staff should follow when handling the animals and animal bedding. Specifically, identify which category of personal protective equipment (PPE) will be required for handling the animals and animal bedding:

☐ Standard PPE [facility scrubs or lab coat over street clothes, facility issued shoes, gloves (only when handling animals or cages) & particle mask (optional)]

☐ ABSL2 PPE (facility scrubs, facility issued shoes, lab coat, shoe covers, gloves & particle mask)

☐ ABSL3 PPE as specified by the facility (e.g. PAPR, etc.)

☐ Additional PPE, please specify: Click here to enter text.

AUP Hazardous Agent Addendum (Pathogenic Organisms)OAWA Version Date: 10/2017