Request for Addition of New Personnel to Animal Use Protocol

UW Institutional Animal Care and Use Committee IACUC Protocol #:

Request for Addition of New Personnel to Animal Use Protocol

(See attached instructions, including submission options and training requirements)

IACUC Protocol PI:

IACUC Protocol Title:

I authorize the IACUC to add the personnel listed below to the referenced IACUC protocol.

PI Signature: ______Date: ______

OR Other person approved on protocol if PI is unavailable to sign:

Printed Name: ______Signature: ______Date: ______

Required information for each person to be added (use additional pages as needed):

Name: Campus Phone (if available):

UW E-mail (and other if applicable) : Department:

Position: Box # (if available):

For this IACUC protocol:

a. List each species you will handle:

b. Indicate years of experience with each species:

c. Check duties specific to this protocol below – repeat for each species:

Species:

Anesthesia / Cervical Dislocation / Decapitation / Handling (awake species)
Orbital Bleeding / Orbital Injections / Survival Surgery

List Other Duties Here:

d. Describe experience for duties listed above in item “c”. If none, indicate how you will be trained (e.g., will be taught by PI or personnel approved on protocol). NOTE: OAW will list your pertinent UW courses below – no need to list them here.

e. If duties include performing survival surgery or administration of anesthesia:

i. Years of experience performing survival surgery at UW (list by species):

ii. Years of experience performing anesthesia on animals at UW (list by species):

CERTIFICATION STATEMENT: I certify that I have read the Project Review Form and that I will only perform procedures that have been approved by the IACUC. I understand that any Significant Changes in procedures must be approved by the IACUC prior to implementation.

Signature: ______Date: ______

INSTRUCTIONS

ADDITION OF NEW PERSONNEL TO IACUC PROTOCOLS

1.  Make sure the new person has completed the UW Laws and Regulations training within the last 5 years. If they have not completed this training, please have them complete the web-based course and exam located at: http://depts.washington.edu/auts/courses_online.html. Please contact the Animal Use Training Coordinator if you need assistance. This requirement should be met prior to submittal of this form to the IACUC since approval cannot be granted until the course is completed.

2.  Enrollment in Occupational Health: If the new person is not already enrolled, please have them complete the Animal Use Medical Screening (AUMS) form. Please note, the AUMS form is electronic and can be accessed at https://ucs.admin.washington.edu/era/uwnetid/aums/Start. A UW NetID and password are required to access the form. If the new person does not already have a UW NetID, please follow the instructions on the UW Information Technology UW NetID webpage.

If you have any questions or concerns about filling out and submitting the AUMS from, please contact the EH&S Occupational Health Nurse at or 206-221-7770.

3.  Complete the New Personnel Form, being sure to provide all requested information and especially:

·  PI's signature (or their designee's signature - this can be anyone already approved on the protocol) in the top box.

·  When listing the person’s duties for this protocol (item “c”), do not list duties that are not pertinent to the protocol. For example, if they have been certified for euthanasia via cervical dislocation, do not check that item as a duty unless it’s applicable to, and approved on, this protocol.

·  Under “d”, make sure to provide complete information regarding duties to be performed and the person's training for those duties/procedures and/or how they will obtain training if they do not already have appropriate expertise.

·  The new person's signature is required for the “Certification Statement". Make sure the person reads and understands the approved IACUC protocol. They will be held responsible for knowing what the IACUC has approved.

4.  Please note: There are specific training requirements for working with certain species (e.g., mice, rats, etc.) and/or for performing certain procedures (e.g., survival surgery, cervical dislocation, etc.). Some are pre-requisites to approval and some are not. Please consult the AUTS webpage for information at:

http://depts.washington.edu/auts/requirements.html

5.  Submittal of New Personnel Form:

·  via e-mail to

·  via campus mail to: Office of Animal Welfare, Box 357160

·  via FAX to: (206) 616-5664

·  via US mail to: Office of Animal Welfare

University of Washington

Box 357160

Seattle, WA 98195-7160

6.  Post-approval Comparative Medicine Vivarium entry requirements: If the new person will need access to a Department of Comparative Medicine vivarium, then prior to entry they must:

·  have completed the SPF Procedures on-line course within the last year

·  take the orientation course for the vivaria to which they will need access

·  Please have the new person register for the above courses, if needed. Contact the Animal Use Training Coordinator for help or additional information.