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To be completed by SPAR
Institutional Animal Care and Use Committee
Animal Study Protocol Review
Schedule C: Biohazard Materials
Directions: All questions must be answered. If some questions are not applicable, please answer NA. After completing the form, print one copy and sign. Submit the original paper copy with signature to Deborah Broome, Office of Sponsored
Programs and Research (Rm. 149 McLaurin Bldg.) as well as an electronic copy via email ( [email protected]
). The electronic copy does not need to show the signature.
This form must be completed for all studies that include the use of biohazards, such as infectious organisms, carcinogens, recombinant DNA or radioisotopes, to be administered to live animals.
Principal Investigator Name:
Has this study been reviewed and approved by the Winthrop University Bio-Safety Committee
If yes, give the Bio-Safety Committee approval number
: and the project title
If approval was not given, explain the circumstances surrounding the rejection
Will the study use In vivo infectious organisms? If yes, describe
Will the study use In vivo chemical carcinogen, endotoxin or toxin? If yes, describe
Will the study use recombinant DNA? If yes, describe
Will the study use In vivo radioisotope? If yes, provide the following information
: a. Labeled Compound
: b. Radioisotope: c. Dose per Animal:
C6. Describe below how the carcass, bedding material or any other relevant waste products will be disposed.
Signature of Principal Investigator
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