UW Oshkosh
Office of Sponsored Programs and Faculty Development
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
INTRA-INSTITUTIONAL ANIMAL TRANSFER AGREEMENT FORM
This agreement is intended for use within the University of Wisconsin Oshkosh, College of Letters and Science Animal Care and Use Program. This agreement allows for transfer of animals between Principal Investigators at UWO or between an investigator’s protocols. Complete this form, obtain signatures, and then return to the Laboratory Animal Manager (x0931). The Lab Animal Manager should have at least 48 hours notice prior to the transfer of any animal.
Please provide the following information:
1. Providing PI and protocol #:2. Receiving PI and protocol #:
3. Date(s) of Transfer:
4. Animal(s) to be transferred: / Species: / Strain:
a) / Sex and Number: / Females: / Males:
b) / Have animals undergone surgical procedures? Yes No If yes, please explain:
c) / Have animals been infected with pathogens, parasites, etc? Yes No
If yes, please explain:
5. Current Location of Animal(s) to be transferred: / Facility: ______/ Building: ______/ Room #:
6. Destination Location of Animal(s) to be transferred: / Facility: ______/ Building: ______/ Room #:
7. Contact and notify the Laboratory Animal Manager of the animal transfer. The lab manager will need to confirm that housing space is available before animals are transferred between facilities and that species and animal use number is approved on a protocol.
a) / Lab Animal Manager notified by:
b) / Date notified:
IMPORTANT: A copy of animal’s individual record should be transferred with the animal so the Receiving PI has access to a complete record of all procedures this animal has experienced.
The undersigned agree to use the animals solely in connection with biomedical or behavioral research or teaching applications or as part of the captive breeding programs at UWO. By signing this agreement, Receiving PI accepts full ownership, custody, control, and care of the animal(s). Providing PI is transferring the animal(s) as a service to research. The animal(s) is/are transferred to the Receiving PI with no warranties or dues, including any warranty of fitness for a particular purpose. The Providing PI and Receiving PI expressly certify and affirm that they are authorized to sign this agreement on behalf of their respective animal colonies, and that the statements made herein are truthful and accurate.
Providing PI: / Phone: / Date:Receiving PI: / Phone: / Date:
Veterinarian Signature: / Phone: / Date:
Lab Animal Manager Signature: / Phone: / Date:
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If requested, relevant documents regarding medical history, breeding, research use of the animal(s) (including prior surgical procedures and exposure to pathogens) are attached to this agreement. Health certificates are also supplied by the Providing PI upon request.
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Last updated: 12/20/2016INTRA-INSTITUTIONAL ANIMAL TRANSFER AGREEMENT FORM Page 1 of 2