Maintenance and Animal Observation Form (rev. 9/10)
Download this form in Word. When finished, e-mail the form to the Attending Veterinarian, John Young, for review. After his review, e-mail the form to iacuc@csulb.edu for placement on an IACUC meeting agenda.
(Note: This form must be typed; handwritten forms will not be accepted.)
| IACUC Project Number: |
- Responsible Faculty Member
- Name:
- Department:
- Office Location:
- Extension:
- E-mail Address:
|
- Description
- Provide a brief explanation and rationale for maintenance and observation of animals in
classroom/office.
|
- Animal Information
- Species/Strain:
- Sex:
- Age/Size:
- Breeding Necessary: Yes ____ No ____
- Vendor Source:
- Number to be maintained:
- Animal Housing Location (Bldg/Rm):
|
- Animal Facilities
- Description of primary enclosure (housing unit for animals).
- Description of routine husbandry including frequency of activity (feeding, watering, cage sanitation,
environmental temperature, etc.).
- Provisions for husbandry of animals during weekdays, weekends, holidays, vacations, etc.
- Provisions for veterinary consultation and/or euthanasia in the event of a health problem.
|
| Signature and Date: |
