APPENDIX 2

TEST SUBSTANCES

  1. Classes of test substances or other materials:

Class / Description / Class / Description
A / Radioisotope / G / Pharmacological agent
B / Infectious agent / H / Adjuvants
C / Carcinogen / I / Antigenic substance
D / Toxic chemical / J / Biomaterial
E / Human material / K / Recombinant Genetic material (vectors)
F / Tissues/cells / L / Other (describe):
The letter of the Class identified above should be listed in column 2 in table below.
  1. List the test substances or other material to be administered to the animals.

Substance Name / Class (See above) / Is test substance hazardous or potentially infectious to humans or animals? / Dose / Dose Schedule (You must include route, frequency and maximum dose per animal)
☐ No / ☐ Yes
☐ No / ☐ Yes
☐ No / ☐ Yes
☐ No / ☐ Yes
☐ No / ☐ Yes
☐ No / ☐ Yes
☐ No / ☐ Yes
If any test substance is hazardous or potentially infectious to humans or animals,
you must complete Appendix 1 and 8.
  1. NOTE: Cells and biologicals to be injected into rodents should be free of contamination with adventitious infectious agents. Otherwise, these materials could introduce infectious agents into our rodent populations. Please provide source below:

☐Primary Human Tumor / ☐Human Cells Propagated in Tissue Culture
☐Rodent Cell Line Propagated in Cell Culture

3A. Are any of the biologicals listed above derived from rodents (e.g. mouse hybridoma /monoclonal antibody) or have rodent biologicals been used in the production or maintenance of these materials (e.g. human cells incubated with media containing mouse serum), or have any of these biologicals been passaged in rodents (e.g cell lines that can only be maintained in vivo)?

☐No. Proceed to item 4. / ☐Yes. Answer 3B and 3C. You must complete Appendix 8.

3B. Have these materials been tested and found to be free of exogenous infectious agents?

☐No / ☐Unknown
☐Yes. Please provide date and method of testing: . Proceed to item c.

3C. Have these materials been passaged ONLY in animals known to be free of exogenous infectious agents?

☐Yes. Proceed to 4. / ☐N/A (not passaged.). Proceed to 4.
☐No. See note below. / ☐Unknown. See note below.
YOU MUST CONTACT DR. L. HERBST, DIRECTOR OF THE INSTITUTE FOR ANIMAL STUDIES, AT EXTENTION: 3571 OR 8553, FOR FURTHER INFORMATION ABOUT SPECIAL ISOLATION CONDITIONS OR TESTING REQUIRED TO USE THESE MATERIALS PRIOR TO USING THEM IN RODENTS.
  1. Will any the test substance(s) cause clinical signs, pain, or distress to the animal?

☐ No / ☐Yes. Answer 4A and 4B.

4A. Describe what signs are expected. Your answer below must be consistent with your response from items 16 and 17 from main protocol form.

Respond below.

4B. Describe what measures will be taken to alleviate or minimize these affects. Your answer below must be consistent with your response from items 16 and 17 from main protocol form.

Measures that will be taken. Respond below.

[1]