Please use this form when adding personnel to a protocol or changing contact information. Contact the Office of the IACUC (OOTI) () for further information.
Protocol Number(s): / Principal Investigator (PI) Name(s): / Department:Last Name: / First Name: / Degree(s):
Institutional Email: / Phone: / Fax:
I am: / ☐ Faculty
☐ Lab Manager / ☐ Scientist
☐ Research Fellow / ☐ Grad Student
☐ Undergraduate / ☐ Technical Staff
☐ Surgeon / ☐ Other: ( / )
Summarize experience with the particular species and procedures on the protocol(s): / Date occupational health questionnaire (OHQ) completed*:
If no prior experience, then indicate the laboratory member responsible for training and note that person’s experience:
AALAS TRAINING. Personnel working with animals must complete online training triennially through the AALAS Learning Library (http://www.aalaslearninglibrary.org/) before they may be listed on a protocol. Instructions on how to access AALAS may be found on the OOTI website (https://iacuc.hms.harvard.edu/forms).
Required for all personnel:
☒ Working with the IACUC
Required for personnel on protocols involving mammals or birds:
☐ Working with BL2-N Infectious Agents in Animals†
☐ Safe Use of Toxic and Hazardous Materials in Animals†
Required for personnel on protocols involving rodents:
☐ HCCM Cage Based Rodent Records and Necessary Forms
Required for personnel performing survival surgery on rodents:
☐ Survival Rodent Surgery† (Initial in-person training with the HCCM; web course is used only for the triennial refresher) / Required for personnel on protocols involving USDA-covered species:
☐ USDA Medical Records† (Initial in-person training with the HCCM; web course is used only for the triennial refresher)
Required for personnel on protocols involving non-human primates:
☐ Working Safely with Non-human Primates†
Required for personnel on protocols involving aquatics:
☐ Working with Laboratory Zebrafish (Required only for zebrafish users)
☐ Working with Laboratory Xenopus (Required only for xenopus users)
☐ Introduction to Amphibians (Required only for amphibian users other than xenopus)
☐ Aquatic Animal Husbandry and Management (Optional/Recommended)
ASSURANCE. By signing below, you attest that the above new personnel (1.) has read the protocol mentioned above; (2.) is familiar with all of its requirements and the requirements of all rules, regulations, and policies governing the care and use of animals relating to their activities; (3.) had the opportunity to ask questions about them; and (4.) understands that all animal experimentation not described in the protocol is prohibited in the absence of an approved amendment.
PI or Lab Manager
Print Name: / Email Address: / Signature/Date:
New Personnel
Signature/Date:
· *Note: Please contact Deborah Beckett (617-432-4658, ) for the OHQ.
· †Note: Those requesting to perform survival surgery, work with USDA-covered species (e.g. NHPs, etc.), and/or work with toxic or infectious materials must receive additional training and/or supervision before working with animals. Contact the HCCM () for more training information.
· When complete, submit form to the OOTI. Please allow 1-2 business days for processing. Work with animals may not begin until the new personnel/PI receive(s) an approval notification from the OOTI. In order to gain access to animal facilities, personnel must attend an in-person facility orientation first.
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