The Authority for Biological and Biomedical Models (ABBM)

The Authority for Biological and Biomedical Models (ABBM)

The Hebrew University

RODENT IMPORT REQUEST FORM

(Importing from other institutions or unapproved vendors)

PART I: REQUESTOR INFORMATION

Date of Request:___/___/___
Principal Investigator: / PI Phone No:
Department: / PI Fax No:
PI E-mail:
Contact Person: / Contact Person Phone No:
Contact Person E-mail:
Ordering Information
Preferred arrival location (after quarantine): ______
Ethical Approval Number of Research: (Please attach a copy of theapproval letter)
______ / Budget to be charged: (if no budget is written, your budget in Animal facility will be charged automatically)
______

* For estimate charges (import, cages in quarantine, health monitoring tests and cesarean section if needed) please contact the ABBM office - 88465.

DESCRIPTION OF ANIMALS –
Complete for each strain. Please attach a separate table if more than one strain is to be imported.
Species:Mice / Rats / Other: ______/ Tg / KO / KI / Other: ______
Quantity to be obtained: Total: ______
No. of Males: ______No. of Females: ______/ Strain name:
Background strain:
Special conditions: / Characteristic of the GM strain:
IMMUNE STATUS
(check one): /  Normal  Undetermined
 T cell deficient  B-cell deficient
 Other, please specify:______
Can this strain/species be obtained from a commercial source? YES  NO
If "YES", indicate why animals must be obtained from this institution: ______
______

Signature of Principal Investigator: ______

PART II: SENDING INSTITUTE INFORMATION

Name and address of Institution from which animals are to be obtained  / `
Name of collaborating Principal Investigator from the exporting institution  / Name:
Phone:
E-mail:
Fax:
Contact person from exporting institution  / Name:
Phone:
E-mail:
Fax:
Institutional Veterinarian  / Name:
Phone:
E-mail:
Fax:
Animals to be shipped are located in:
Facility: ______Unit: ______room: ______

Important informationregarding the mice shipment:

• NO ANIMALS ARE TO BE SHIPPED UNTIL A WRITTEN APPROVAL HAS BEEN GIVEN BY THE ANIMAL FACILITY VET OR SHIPPING COORDINATOR.
• Animal transfer approval is valid for 30 days. In case of delay, re-approval of health status and shipment is needed.
• The shipment should arrive between Sunday morning and Wednesday night.

• The number of mice and the number of boxes should be indicated by mail prior to shipment.
• A proforma invoice for customs purpose including description, quantity and values is to be filled out.
• The shipment is to be accompanied by a government veterinary certificate. Please see attached (at the end of this form) an example for the required form.

PART III: ANIMAL HEALTH INFORMATION

(To be filled by the sending institute veterinarian)

Specific Animal Facility Description

Caging system: Individually Ventilated Filter-top cages Conventional (open-top) Other: ______

Use of decontaminated: - Food Yes No - Water Yes No - Bedding Yes No

Protective measures for staff: Mask Gloves Shoe Covers Disposable Clothing Change Hoods Shower-In

Do incoming animals come from multiple sources?YesNo
Do you receive rodents from non commercial vendors? YesNo
Are non-vendor rodents introduced into the facility without prior screening?: Yes No
Can rodents be returned to room after removal from the animal facility ?: Yes No
To which Animal Biosafety Level (ABSL) belong the mice you will send?
ABSL-1 ABSL-2 ABSL-3
Breeding in room?Yes No

Health monitoring program

Is There a health monitoring program at your facility? Yes No
Sentinels on dirty bedding? Yes No (please give details) :
Diagnostic tests performed:
Ectoparasites Endoparasites Bacteriology Viral Serology
Does your facility follow FELASA recommendations for animal monitoring ?: Yes No
Frequency of monitoring:
Does the rodent health information submitted with the rodent transfer request correspond to:
the entire facility/unit the room where the animals are housed
Other:______
Have any health problems or pathogens been found in your facilitywithin the last 12 months: Yes No
Have any health problems or pathogens been found in the room within the last 12 months: Yes No
Please list the pathogens or health problems: ______
______
Please describe actions and treatments that have been administered in your animal facility within the last 12 months: ______
______

Please forward an updated health reports, including historical results of the last 18 months and clearly mention the room/s from which animals will be imported.

Please e-mail this completed form and the health reports to the contact person in the lab in The Hebrew University or to the shipping coordinator of ABBM.

Veterinarian: ______

(Printed name) (Signature) (Date)

Example of the required government veterinary certificate

מדינת ישראל

STATE OF ISRAEL

MINISTRY OF AGRICULTURE AND RURAL DEVELOPMENT

VETERINARY SERVICES & ANIMAL HEALTH

Veterinary Health Certificate to accompany rodents

imported from ______to Israel

Description of the animals

Species (scientific name) / Breed / Number / Sex / Age / Colour

Origin of the animals (name and address of breeder)

______

Destination of the animals (name and address of consignee)

______

Health Information

I the undersigned, official veterinarian, certify that the animal described above meet the following conditions:

1. They originate from premises which are under permanent veterinary supervision.
2. The animals were born in the establishment of origin and have stayed there since birth;Or[1]were introduced into the establishment of origin at least thirty (30) days ago;
3. The animals originate and come from an establishment under veterinary surveillance and in which a program for the monitoring of zoonotic diseases is in place;
4. No outbreaks of Rabies, Monkey Pox,Lymphocytic Choriomeningitis, Tularaemia,Leptospirosis, Hemorrhagic Fever with Renal Syndrome, Hantavirus Pulmonary Syndrome were been clinically diagnosed in the establishment for the last twelve (12) months.
5. The animals do not present any clinical signs of zoonotic diseases, in particular Rabies, Monkey Pox, Lymphocytic Choriomeningitis,Tularaemia, Leptospirosis,Hemorrhagic Fever with Renal Syndrome, Hantavirus Pulmonary Syndrome;
6. The animals were examined within 48 hours of loading and did not present any clinical signs of disease or suspected disease and were considered fit for transportation.

Date ______

Official Veterinarian

Place ______Signature ______

Official Seal

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[1]Delete as appropriate