PROTOCOL FOR ANIMAL USE AND CARE Email to: campusvet@ucdavis.edu Investigator Last Name: Last Name: First: First: Middle: Middle: email: email: Department: Department: Phone / Fax: Phone: After hrs. #: After hrs. #: EH&S USE ONLY 10579 PROTOCOL: 10579 EXPIRES: 4/24/04 Contact Species (common names): Number: Source: Titi monkeys 60 Parque Nacional del Manu, Peru Project Title Overnight housing location:: Animals will be maintained by: The frequency of trichromatic color vision in a wild population of Callicebus moloch, a New World monkey Day use: [ ] Vivarium [ ] Investigator (If investigator maintained, attach husbandry SOP s.) Procedures: Provide a one or two sentence layman's description of the procedures employed on the animals in this project. This information will help the animal care staff understand any conditions they may encounter while caring for your animals. We will be marking (with hair-dye) and collecting hair samples from approximately 60 wild titi monkeys (Callicebus moloch) in El Parque Nacional del Manu, Peru, using minimally-invasive adhesive marking darts (which we have specially designed for this purpose) fired from an air rifle. Special Husbandry Requirements: Describe any special requirements your animals have with respect to food, water, temperature, humidity, light cycles, caging type, bedding, or any other conditions of husbandry. The study will take place in the field. The animals are wild and will not be captured or handled. Other instructions for animal care staff: (check applicable entries) Sick Animals Dead Animals Pest Control [ ] Call Investigator [ ] Call Investigator [ ] Call Investigator [ ] Clinician to treat [ ] Save for Investigator [ ] OK to use pesticides [ ] Terminate [ ] Bag for disposal [ ] No Pesticides in animal area [ ] Necropsy [ ] Necropsy Hazardous Materials (only if in the animal room): Infectious Agents? [ ] Yes [ ] No Agent(s): Radioisotopes? [ ] Yes [ ] No Agent(s): Chemical Carcinogens? [ ] Yes [ ] No Agent(s): Printed 11/19/2003 9:11 AM Page 1
Toxic Chemicals? [ ] Yes [ ] No Agent(s): 10579 Printed 11/19/2003 9:11 AM Page 2
Funding source: OTS, Sigma Xi, UC Summer Research Fellowship (all applications pending) Previously approved? Is the project already funded? [ ] Yes [ x ] No Previous protocol number (if any): none What Veterinarian or veterinary clinic will provide care for your animals? (check one) [ ] Yes [ x ] No [ ] Lab Animal Health Clinic ( 2-0514 ) [ ] California Primate Research Center ( 2-0447 ) [ ] VMTH Large Animal Field Service ( 2-0292 ) [ ] Another Veterinarian If you checked Another Veterinarian, please provide: 10579 Veterinarian: Address: Day phone: Emergency phone: Email: If your veterinarian is not affiliated with one of the three service units listed above, please contact the campus veterinarian, 2-2357 (email pctillman@ucdavis.edu) for current information about training and record keeping requirements. Summary of Procedures: a) Briefly describe the overall intent of the study. Include in your description a statement of your hypothesis, the objectives and significance of the study. Your target audience is a faculty member from a discipline unrelated to yours. Do not use jargon. Old World monkeys, apes, and humans (catarrhines) are unique among mammals in having trichromatic color vision, which affords the ability to distinguish between shades of red and green (among other colors). In contrast, most other diurnal mammals are dichromats, having color perception similar to that of a human who is red-green colorblind. The New World primates (platyrrhines) are unusual in having a polymorphism at the gene locus for one of their two retinal photopigments (which is located on the X-chromosome) and this results in a system in which the majority of female animals (being heterozygous at this locus) are trichromats, whereas all males and a smaller percentage of females (homozygotes) have dichromatic vision. It is unclear whether this system of polymorphic vision in New World primates is evolutionarily stabile, or whether it is merely an intermediate step in the evolution of the invariable trichromacy found in the Old World primates. Understanding the evolutionary forces acting on polymorphic vision in the platyrrhines will give us insight into how and why trichromacy originally evolved in the catarrhines, and thus, why humans perceive color the way we do. We will use the titi monkey (Callicebus moloch) as a model species to test the hypothesis that trichromatic females have a fitness advantage over dichromatic females in a natural environment. Five visual pigment phenotypes have been found in captive male titis, thus implying the presence of 5 alleles at the polymorphic pigment locus. Based on the frequencies of these alleles in a natural population, we can calculate what proportion of trichromatic and dichromatic females are born each generation using principles of Mendelian inheritance. For this project, we will be sampling adult females in a natural population to determine the frequency of each allele and the actual proportion of trichromatic/dichromatic adult females. If the actual proportion of trichromatic/dichromatic adult females differs significantly from that predicted by Mendelian inheritance (via Chi-Square analyses), we will interpret this as evidence of natural selection operating on color vision in these monkeys. Another important goal of this project is to test the effectiveness of a new minimally-invasive DNA collection method under field conditions. we Printed 11/19/2003 9:11 AM Page 3
10579 will be collecting hair samples with specially modified adhesive darts which also mark the pelage of the animals with 1mL of hair dye (so that individuals will not be sampled more than once over the course of the project). If successful, this method may prove to be much safer (for both animals and researchers) than the traditional method of collecting DNA from wild monkeys via tranquilization and immobilization. b) Procedures employed in this project: Please check the appropriate boxes if any of these procedures will be employed in your project: [ ] Monoclonal Antibody Production ** [ ] Food or water restriction [ ] Special diets; food or water treatment. [ ] Polyclonal Antibody Production ** [ ] Non-recovery surgical procedures [ ] Induced illness, intoxication, or disease [ ] LD 50 or ID50 studies. [ ] Survival surgical procedures [ ] Death as an endpoint (see i below) [ ] catheters, blood collection, intubation [ ] Multiple survival surgery [ x ] Trapping, banding or marking wild animals [ ] Prolonged restraint. (8 hrs+) [ ] Behavioral modification. [ ] [ ] Fasting prior to a procedure. [ ] Aversive conditioning. [ ] ** If this protocol only describes antibody production, you may use the attached antibody production page in lieu of completing section c below. Printed 11/19/2003 9:11 AM Page 4
10579 c) Describe the use of animals in your project in detail, with special reference to any of procedures checked above. Include any physical, chemical or biological agents that may be administered. List each study group, and describe all the specific procedures that will be performed on each animal in each study group. Use terminology that will be understood by individuals outside your field of expertise. (Note: This cell will expand to whatever length you require. You may make this section as long as you wish, but try to be concise. Some projects may require one or two pages.) Hair samples will be collected from 60 wild monkeys using Telinject Vario brand 1cc plastic adhesive marking darts (12cm long X 11mm diameter) that we have modified specifically for this project. The darts contain 0.5mL Revlon 11N Colorsilk brand ammonia-free permanent hair dye diluted with 0.5mL 3% hydrogen peroxide in an internal chamber that is hand-pressurized with 5mL of air. The front end of the dart has an opening connecting to the pressurized dye chamber. This opening is sealed with Parafilm. A rubber serum vial stopper is fitted onto the end of the dart on top of the parafilm and sealed with thin-gauge copper wire. A thin copper tube is inserted through the rubber stopper until it is suspended just above the Parafilm seal. The other end of the copper tube (the end that will strike the animal) flares out to a flat round surface of 8mm diameter. Firmly taped to the outside of the dart are two strips (6cm long X 8mm wide) of thin cardboard impregnated with Safer brand poison-free white fly trapping glue. These adhesive strips extend beyond the front end of the dart and pinch together at their tips above the flared end of the copper tube. The entire body of the dart is covered with Tabasco brand pepper sauce to deter the animals from chewing the dart. The darts are fired with a Telinject 1V Breechloading pistol powered by a footpump with a pressure gauge. This gun has an effective range of 30m, but will not be used for monkeys further than 20m away. The amount of air pressure used to charge the gun will be the minimum necessary to ensure that the dart reaches the intended target accurately. We will always aim for the rumps of the animals. Upon striking the pelage of the monkey, the dart s adhesive strips will crumple against the flared end of the copper tube, thereby compressing the rubber stopper, forcing the other end of the copper tube through the Parafilm seal, and thus ejecting the pressurized 1mL contents of the dye chamber through the copper tube and onto the pelage of the monkey. The dye will eject onto an area with a radius of approximately 1.5 inches around the place where the dart strikes (though a small amount of excess dye may dribble down the fur). The adhesive strips will affix the dart to the monkey s pelage until the animal pulls the dart off, at which point a few strands of hair will remain adhered to the strips. Ideally, the monkey will immediately drop the dart so that we can collect it. The animals be deterred from chewing the dart by the covering of pepper sauce. d) Study Groups and Numbers: Define, in the form of a table, the numbers of animals to be used in each experimental group described above. The table may be presented on a separate page as an attachment to this protocol if you prefer. The Normal format should be three columns: Study Group, Procedure, Number of animals. The number of rows should follow from the number of study groups; you may add as many rows as you require. The chart must fully account for the number of animals you intend to use under this protocol. Assign each group to an invasiveness category according to the chart below. Group Procedures / Drugs Number of Animals Category 1 Collect hair, mark pelage with dye 60 1 Printed 11/19/2003 9:11 AM Page 5
Category 1 2 3 4 Description Little or no discomfort or stress Categories of invasiveness Examples: domestic flocks or herds being maintained in simulated or actual commercial production management systems; the short-term and skillful restraint of animals for purposes of observation or physical examination; blood sampling; injection of material in amounts that will not cause adverse reactions by the following routes: intravenous, subcutaneous, intramuscular, intraperitoneal, or oral. Minor stress or pain of short duration Examples:: cannulation or catheterization of blood vessels or body cavities under anesthesia; minor surgical procedures under anesthesia, such as biopsies or laparoscopy; short periods of restraint beyond that required for simple observation or examination, but consistent with minimal distress Moderate to severe distress Examples: major surgical procedures conducted under general anesthesia, with subsequent recovery; prolonged (several hours or more) periods of physical restraint; induction of behavioral stresses such as maternal deprivation Severe pain near, at or above the pain tolerance threshold Examples: exposure to noxious stimuli or agents whose effects are unknown; exposure to drugs, chemicals, or infectious agents at levels that markedly impair physiological systems and which cause death, severe pain, or extreme distress: Surgical experiments which have a high degree of invasiveness. 10579 Further descriptions of these categories are included in the instructions following this document. e) Rationale for species and numbers: How did you determine that 1) the species choice was appropriate and 2) the number of animals in each study groups was the minimum number necessary to achieve sound scientific results? Titi monkeys (Callicebus moloch) are a good model species to test our hypotheses because they are one of the few monogamous New World monkeys. Only a single adult female is present in any given territory, thus interactions between females with different color vision types (which could potentially confound fitness comparisons) are minimized. We will be collecting genetic samples from approximately 60 animals (30 females and 30 males). Based on the inferred 5 alleles at the gene locus for the long/middle wave retinal photopigment in titis, and making the most conservative prediction that all 5 alleles are equally frequent in natural populations, a power analysis for a chi-square test reveals a sample size of 30 as being the minimum sample size affording sufficient power to accept a null hypothesis. Thus we need to sample 30 females in order to test our hypothesis of fitness differences between dichromats and trichromats. In addition, the male mates of each of these 30 females will be sampled to yield a more accurate estimate of allele frequencies in natural populations. This will also allow us to control for assortative mating (choosing mates based on color vision type) which may influence the fitness of females. f) Surgery: If the project involves survival surgery, where will the surgery be conducted? Building: Who will be the surgeon? Room: g) Anesthetics, Analgesics, Tranquilizers, Neuromuscular blocking agents: Post procedural analgesics should be given whenever there is possibility of pain or discomfort that is more than slight or momentary. If postoperative analgesics are not to be given, justify the practice under part (i) below. Provide the following information about any of these drugs that you intend to use in this project. Species Drug Dose (mg/kg) Route When and how often will it be given? Printed 11/19/2003 9:11 AM Page 6
10579 h) Neuromuscular blocking agents can conceal inadequate anesthesia and therefore require special justification. If you are using a neuromuscular blocking agent, please complete the following: Why do you need to use a neuromuscular blocking agent? What physiologic parameters are monitored during the procedure to assess adequacy of anesthesia? Under what circumstances will incremental doses of anesthetics-analgesics be administered? i) Adverse effects: Describe any potential adverse effects of the experiment on the animals (such as pain, discomfort; reduced growth, fever, anemia, neurological deficits; behavioral abnormalities or other clinical symptoms of acute or chronic distress or nutritional deficiency) 1.The monkeys may be bruised by the initial impact of the hair collection darts if too much pressure is used to power the air gun. 2.A monkey may get the marking dye in its eyes or mouth if the dart strikes within 1.5in of the face or in a location on the body where the animal can lick. 3.A monkey may chew the dart, break it, and subsequently ingest pieces of the dart. 4.The artificial markings on the monkeys may effect intra-group social interactions and/or make them more conspicuous to predators. How will the signs listed above be ameliorated or alleviated? If signs are not to be alleviated or ameliorated by means of postoperative analgesics or other means, explain why this is necessary. 1.The striking surface of the dart is padded by the crumpling of the thin cardboard adhesive strips which reduce the force of the impact. Through practice (on non-living targets) the minimal amount of air pressure to accurately propel the dart to the intended target will be determined for a range of target distances. Even if struck hard, the darts should not puncture the skin. The process of pulling the dart from the pelage should cause minimal discomfort as only a few hairs are involved. 2. All precautions will be taken to hit the monkeys on the rump (as far from the face as possible). This may mean waiting hours for a clear shot. The very small amount of marking substance used (1mL) should minimize the risk of serious injury should the animal lick the dye. 3. This risk is minimized by covering the dart with Tabasco brand pepper sauce, which should effectively deter chewing while causing only short term discomfort. Printed 11/19/2003 9:11 AM Page 7
4. The small amount of marking dye administered to the animals will slightly bleach a small spot on their pelage. I feel it is unlikely that such a small discoloration will have a negative impact on either social relations or predator visibility, especially if the marking is on the rump area. 10579 Note: if any unanticipated adverse effects not described above do occur during the course of the study, a complete description of those effects and the steps taken to mitigate them must be submitted to the committee as an amendment to this protocol. Is death an endpoint in your experimental procedure? [ ] Yes [ x ] No (Note: "Death as an endpoint" refers to acute toxicity testing, assessment of virulence of pathogens, neutralization tests for toxins, and other studies in which animals are not euthanized, but die as a direct result of the experimental manipulation). If death is an endpoint, explain why it is not possible to euthanize the animals at an earlier point in the study. If you can euthanize the animals at an earlier point, describe the clinical signs which will dictate that an animal will be euthanized. j) Literature search for alternatives and unnecessary duplication: Federal law specifically requires this section. You are required to conduct a literature search to determine that either 1) there are no alternative methodologies by which to conduct this class/lab, or 2) there are alternative methodologies, but these are not appropriate for your particular class/lab. "Alternative methodologies" refers to reduction, replacement, and refinement (the three R's) of animal use, not just animal replacement. You must also show that this use of animals is not unnecessarily duplicative of other studies. UC Davis provides on-line access to a number of databases that can be used to search for alternatives. Visit http://trc.ucdavis.edu/jawelsh/databases_med_vet_researchers.htm (email: jawelsh@ucdavis.edu) or http://www.vetmed.ucdavis.edu/animal_alternatives/main.htm (email: mwwood@ucdavis.edu) What was the date on which you conducted this search? April 10, 2003 List the databases searched or other sources consulted (there should be more than one). Include the years covered by the search. Database Name Years Covered Keywords / Search Strategy BIOSIS Previews 1969-2003 DNA collection (and) noninvasive Anthropological Literature Current Contents 1993-2003 Wildlife and Ecology Studies Worldwide 1984-2003 DNA collection (and) primates 1935-2003 DNA collection What were your findings with respect to alternative methodologies? DNA collection (and) noninvasive Documented methods of non-invasive DNA collection include hair collection through baited hair traps, fecal collection, and urine collection. None of these methods are satisfactory because, for the present study, the precise identity of the animal from which DNA samples are collected must be known. A single study employing hair collection from primates via adhesive darts was found. The study employed very similar darting equipment to that which will be used in the present study, however the darts did not mark the pelage of the animals (a necessity for the present study with a large sample size of un-habituated and virtually indistinguishable monkeys). We have contacted the principal investigator of this study and she has provided us with valuable suggestions which have been incorporated into the proposed darting procedure. Has this study been previously conducted? [ ] Yes [x ] No Printed 11/19/2003 9:11 AM Page 8
10579 If the study has been conducted previously, explain why it is scientifically necessary to replicate the experiment. k) Disposition of animals: At what point in the study, if any, will the animals be euthanized? never l) Methods of euthanasia: Even if your study does not involve killing the animals, you should show a method that you would use in the event of unanticipated injury or illness. If anesthetic overdose is the method, show the agent, dose, and route. Species Method Drug Dose (mg/kg) route m) Surplus animals: What will you do with any animals not euthanized at the conclusion of the project? Printed 11/19/2003 9:11 AM Page 9
10579 n) Project Roster: Please provide the names of all the individuals who will work with animals on this project. This page will not be made available to the public. Give either the University Employee ID # or a valid UC Davis email address so that we can document training and occupational health compliance for regulatory agencies. Include all investigators, student employees, post-doctoral researchers, staff research associates, post-graduate researchers and laboratory assistants who will actually work with the animals. You don t need to include the staff of the vivarium in which your animals will be housed. The principal investigator is responsible for keeping this roster current. If any staff is added or subtracted from this project, you must amend the protocol by sending the campus veterinarian a memo describing any changes. Last Name First Name Middle Name UC ID Number or SSN Email Address Occupational Health Program: Supervisors must enroll their employees in the campus Occupational Health Program if the workers are at increased risk of illness or injury (such as allergy, physical injury, or infectious disease) because of their work. Enroll workers by having them complete an "Animal Contact History Form", available from Employee Health Services (phone 752-2330). For further information, visit our web site at http://ehs.ucdavis.edu/animal/health/ or read the UC Davis Policy & Procedure Manual 290-25. Training: Supervisors are responsible for insuring that their employees are adequate trained, both in the specifics of their job and in the requirements of the Federal Animal Welfare Act. EH&S offers free, basic wet labs in laboratory animal handling and techniques, and lecture format classes in the requirements of the Animal Welfare Act. To schedule a class for your unit, contact EH&S at 2-2364. Information is available on the world wide web at http://ehs.ucdavis.edu/. Printed 11/19/2003 9:11 AM Page 10
Assurances for the Humane Care and Use of Vertebrate Animals: Principal Investigator's Statement: 10579 I have read and agree to abide by the UC Davis Policy and Procedure Manual section 290-30 (Animal Use and Care). This project will be conducted in accordance with the ILAR Guide for the Care and Use of Laboratory Animals, and the UC Davis Animal Welfare Assurance on file with the US Public Health Service. (These documents are available from the Campus Veterinarian and at http://ehs.ucdavis.edu/ ). I will abide by all Federal, state and local laws and regulations dealing with the use of animals in research. I will advise the Animal Use and Care Administrative Advisory Committee in writing of any significant changes in the procedures or personnel involved in this project. Principal Investigator Rank / Title Date ** Conditions necessary for Committee Approval: Committee Use Only Below Final Disposition of this protocol: Approved Not Approved Withdrawn by Investigator Date of Action: / / I verify that the Institutional Animal Care and Use Committee of the, acted on this protocol as shown above. Campus Veterinarian Date Printed 11/19/2003 9:11 AM Page 11
10579 Antibody Production Project Description If your project involves only antibody production, either polyclonal or monoclonal, you may complete this page in lieu of section c), project description. c) Will these animals be used for antibody production? [ ] Yes [ ] No 1. Polyclonal or Monoclonal antibodies? If Monoclonal, will you be producing ascites tumors in the animals? [ ] Yes [ ] No 2. What type(s) of antigen will be used? Will the antigens be sterile? 3. What adjuvant will be used for the initial injection? What adjuvant will be used for subsequent injections? 4. What route will be used for injections? What anatomical location will be injected? How many injections at one time? How frequently will injections be given? What volume will be injected at each site? 5. Polyclonal Blood collection Procedures: Who will collect the blood? From what anatomical location? How frequently will blood be collected? Will the animals be sedated? [ ] Yes [ ] No Volume? 6. Will monoclonal antibodies be produced in mice bearing ascites tumors? [ ] Yes [ ] No How often will the animals be assessed for abdominal distention? How often will they be tapped? How many times will they be tapped? Will the animals be sedated for tapping? Note: If you are producing monoclonal antibodies using ascites tumors in mice, section j), alternatives, must explain why an invitro system is not suitable for your study. 7. Sedation / Anesthesia for blood or ascites collection: If the animals will be sedated for either injections or collections, please indicate the species, drug, dose and route: Species Drug Route Dose (mg / kg) h) What criteria will be used to determine that the animals should be euthanized rather than continue to be used? Printed 11/19/2003 9:11 AM Page 12
Categories of Invasiveness in Animal Experiments Use these categories when completing item d), Study Groups and Numbers 10579 Each year, the US federal government requires a report from the campus in which animal projects are categorized as to degree of invasiveness. Please assist the IACUC in this determination by assigning the animal procedures in your project to one of the categories below. The US Government Principles Regarding the Care and Use of Animals state, Unless the contrary is established, investigators should consider that procedures that cause pain or distress in human beings may cause pain or distress in other animals. 1. Experiments which cause little or no discomfort or stress. ** Examples: domestic flocks or herds being maintained in simulated or actual commercial production management systems; the short-term and skillful restraint of animals for purposes of observation or physical examination; blood sampling; injection of material in amounts that will not cause adverse reactions by the following routes: intravenous, subcutaneous, intramuscular, intraperitoneal, or oral, but not intrathoracic or intracardiac (Category 2); acute non-survival studies in which the animals are completely anesthetized and do not regain consciousness; approved methods of euthanasia following rapid unconsciousness, such as anesthetic overdose or decapitation; short periods of food and/or water -deprivation equivalent to periods of abstinence in nature. 2. Experiments which cause minor stress or pain of short duration. Examples:: cannulation or catheterization of blood vessels or body cavities under anesthesia; minor surgical procedures under anesthesia, such as biopsies or laparoscopy; short periods of restraint beyond that required for simple observation or examination, but consistent with minimal distress; short periods of food and/or water deprivation which exceed periods of abstinence in nature; behavioral experiments on conscious animals that involve short-term, stressful restraint: short term exposure to noxious but non-lethal levels of drugs or chemicals. Such procedures should not cause significant changes in the animal s appearance, in physiological parameters such as respiratory or cardiac rate, or fecal or urinary output, or in social responses. 3. Experiments which cause moderate to severe distress or discomfort Examples: major surgical procedures conducted under general anesthesia, with subsequent recovery; prolonged (several hours or more) periods of physical restraint; induction of behavioral stresses such as maternal deprivation, aggression, predator-prey interactions; procedures which cause severe, persistent or irreversible disruption of sensorimotor organization; the use of adjuvants which cause clinically evident swelling or abscesses. Other examples include induction of anatomical and physiological abnormalities that will result in pain or distress: the exposure of an animal to noxious stimuli from which escape is impossible; the production of radiation sickness; exposure to drugs or chemicals at levels that impair physiological systems. Note: procedures used in Category 3 studies should not cause prolonged or severe clinical distress as may be exhibited by a wide range of clinical signs, such as marked abnormalities in behavioral patterns or attitudes, the absence or grooming, dehydration, abnormal vocalization, prolonged anorexia, circulatory collapse, extreme lethargy or disinclination to move, and clinical signs of severe or advanced local or systemic infection, etc. 4. Procedures which cause severe pain near, at, or above the pain tolerance threshold of unanesthetized conscious animals Examples: exposure to noxious stimuli or agents whose effects are unknown; exposure to drugs or chemicals at levels that (may) markedly impair physiological systems and which cause death, severe pain, or extreme distress: completely new biomedical experiments which have a high degree of invasiveness; behavioral studies about which the effects of the degree of distress are not known; use of muscle relaxants or paralytic drugs without anesthetics; burn or trauma infliction on unanesthetized animals; a euthanasia method not approved by the American Veterinary Medical Association; any procedures (e.g. the injection of noxious agents or the induction of severe stress or shock) that will result in pain which approaches the pain ** The text of these categories has been freely adapted from a document originally published by the Canadian Council on Animal Care (CCAC). Printed 11/19/2003 9:11 AM Page 13
10579 tolerance threshold and cannot be relieved by analgesia (e.g. when toxicity testing and experimentally-induced infectious disease studies have death as the endpoint). Printed 11/19/2003 9:11 AM Page 14
10579 ANIMAL ROOM SAFETY INFORMATION Complete this form if you will be using biohazards, radioisotopes, carcinogens, or toxic chemicals in the animal room. PROTOCOL # EXPIRES: RUA#: BUA#: CCA#: Identity of Hazard: Investigator Last Name: Department: First Name: Phone: Email: Fax: Provide a short description of the agent: This agent / material is hazardous for: [ ] Humans only [ ] Animals only [ ] Humans and Animals For which Animal Species? The agent can be spread by: [ ] Blood [ ] Feces/urine [ ] Saliva/nasal droplets [ ] Does not leave animal [ ] Other: Describe any human health risk associated with this agent: The precautions checked below apply to this experiment: [ ] The researcher or his/her technicians are responsible for the feeding and care of these animals. [ ] The following items must be assumed to be contaminated with hazardous material and must be handled only by the researcher or his/her technicians. [ ] Cage [ ] Stall [ ] Water Bottle [ ] Animal Carcasses [ ] Bedding [ ] Other: [ ] Cages must be autoclaved before cleaning. [ ] Label cages and remove label after decontamination. [ ] Animal carcasses must be labeled and disposed of as follows: [ ] Incineration [ ] Biohazardous Waste Container [ ] Bag and Autoclave [ ] EH&S will pick-up (2-1493). [ ] All contaminated waste (soiled bedding or other animal waste) must be properly labeled and disposed of as follows [ ] Incineration [ ] Biohazardous Waste Container [ ] Bag and Autoclave [ ] EH&S will pick-up (2-1493). Personal Protective Equipment Required: [ ] The following personal protective equipment must be worn/used in the room: [ ] Lab Coat/Coveralls [ ] Shoe Covers/Booties [ ] Disposable Gloves [ ] Head Cover [ ] NIOSH Certified Dust Mask [ ] Disinfectant footbath [ ] Eye Protection/Face Shield [ ] [ ] Fitted Respirator Type: [ ] Other: Describe: [ ] Personal protective equipment must be removed before leaving the room. [ ] Personal protective equipment must be discarded or decontaminated at the end of the project [ ] Hands, arms, and face must be thoroughly washed upon leaving the room [ ] Full shower, including washing of hair, must be taken upon leaving the room. [ ] Decontaminate Room (Inform ARS area supervisor when cage and/or room can be returned to general use). Provide any other information needed to safely work in this room: Printed 11/19/2003 9:11 AM Page 15
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