Biosafety Research Protocol – Notice of Intent
ADDENDUM II: Use of Hazardous Agents in Animals
To ‘check’ a box (), double click on the box and select “Checked” in the Default Value section!
NOTE: FOR IBC USE ONLY
Date Received:
IBC Protocol #:
Date Reviewed:
1. Principal Investigator:
2. Project Title:
3. PI Email:
4. PI Phone:
1. IACUC Protocol Number:
Approval Date:
(if applicable)
IACUC Protocol Title:
2. Species of animal (include invertebrates and vertebrates):
3. Field caught? (Use of animals that are potential reservoirs of zoonotic diseases)
4. Transgenic or other genetically modified animals?
Yes
Yes
No
Yes
No
No
5. Infectious agents, vectors, or human cell lines used in live animals?
If yes, identify:
6. Hazardous chemicals/toxins in animals?
Yes
No
If yes, identify:
If question 5. or 6. above was answered “Yes,” complete questions below.
1. Maximum infectious/hazardous dose per animal:
2. Maximum infectious units per dose:
3. Method of Delivery:
Animal anesthetized during injections of agent:
Yes
No
Biosafety Research Protocol Form – Addendum II: Animal-Related Biohazards
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Animal restrainers used for injecting hazardous materials:
Yes
No
4. Agent excreted/shed?
Yes
No
If yes, explain the measures your lab will take to prevent accidental exposure to employees, animal
handlers, students, visitors or other animals:
Biosafety Research Protocol Form – Addendum II: Animal-Related Biohazards
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ANIMAL HANDLER PRECAUTIONS
Principal Investigator:
Phone:
Emergency contact person:
Phone:
Building:
Room number:
Date:
IACUC PROTOCOL/S:
Please list the agent/s used in the appropriate box (click inside the box to add text):
BIOLOGICALS (to be used in
animal experimentation or on
animal carcasses)
CHEMICALS (to be used in
animal experimentation or on
animal carcasses)
RADIATION (to be used in
animal experimentation or on
animal carcasses)



If applicable, please provide your Radiation Safety Permit #:
The precautions checked below apply to this experiment.
Identified hazard/s:
The researcher or his/her technicians are responsible for the feeding and care of these animals.
Individual cages are labeled with appropriate warning labels.
The following items must be assumed to be contaminated with hazardous materials and must be
handled only by the researcher or his/her technicians:
Cage
Bedding
Water bottle
Animal carcasses
Equipment (specify):
.
Environmental Health and Safety MUST dispose of animal carcasses; call EH&S at (704) 687-1111.
ALL contaminated waste must be disposed of through Environmental Health & Safety at (704) 6871111.
Filter top cages MUST be opened in a biological safety cabinet.
The following personal protective equipment MUST be worn/used in this room:
Lab coat/Coveralls
Head cover
Eye protection
Shoe covers
Surgical mask
Gloves (double)
Respirator (list make/model/type filter):
Other:
.
Hands MUST be thoroughly washed upon leaving the room.
Current Medical Surveillance Clearance is required for entry.
Other:
.
Biosafety Research Protocol Form – Addendum II: Animal-Related Biohazards
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