Death and Disposition Record
For unscheduled* euthanasia or animals found dead.
**Please complete applicable sections**
Facility___________________
Date_____________
Reported By______________________ Phone #__________________
Animal I.D.#____________________ and/or # of animals_______________
Species______________ Age_____ Sex______ Breed__________________
Source____________________
Delivery Date________________
PACUC #___________
Principal Investigator_____________________ Phone #_____________________
Other Responsible Individual__________________________ Phone #____________
Does this animal have a current/open Clinical Activity Report? Yes ____ No ____
Was animal found dead? Yes___ No___
Date/time found____________________
Was animal euthanized?_________________ Date/time _________________
Please give a brief history of this animal below:
*Unscheduled euthanasia would include animals euthanized due to illness, injury, or
other conditions not related to the study.
08/2010
