Document 11987058

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IACUC001C

04/25/2008

Page 1 of 2

IACUC #

To be completed by SPAR

Winthrop University

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.

C4

C5

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:

Project Title:

Yes No

C1

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

:

C2

C3

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.

IACUC001C

04/25/2008

Signature of Principal Investigator

Page 2 of 2

Date

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