CALIFORNIA STATE UNIVERSITY, LONG BEACH

INSTITUTUIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)

ANIMAL OBSERVATION FORM (rev. 9/05)

Copy this form from your web browser and complete. When finished, e-mail the form to the Attending Veterinarian, John Young, for review.  After his review, e-mail the form to research@csulb.edu for placement on an IACUC meeting agenda.

(Note: This form must be typed; handwritten forms will not be accepted.)

IACUC Project Number ________

I. RESPONSIBLE FACULTY MEMBER

Name ____________________________ Department __________________________

Office Location ____________________ Extension _____________________

E-mail Address _______________________

II. DESCRIPTION

Provide a brief explanation and rationale for maintenance and observation of animals in classroom/office.

III. ANIMAL INFORMATION

A. Species/Strain ______________ B. Sex _______________

C. Age/Size __________________ D. Breeding Necessary: YES ____ NO ____

E. Vendor Source _____________ F. Number to be maintained ______________

G. Animal Housing Location (Bldg/Rm) ____________________

IV. ANIMAL FACILITIES

A. Description of primary enclosure (housing unit for animals).

B. Description of routine husbandry including frequency of activity (feeding, watering, cage sanitation, environmental temperature, etc.).

C. Provisions for husbandry of animals during weekdays, weekends, holidays, vacations, etc.

D. Provisions for veterinary consultation and/or euthanasia in the event of a health problem.

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SIGNATURE & DATE