Verification of Tetanus Inoculation
(for Non-Students)
Instructions: Occupational Health and Safety Guidelines state that all persons working
with animals should have updated tetanus inoculations. This form must be completed by
all persons associated with an IACUC protocol who are not Loyola graduate or
undergraduate students, (e.g., faculty, staff, post-doctoral fellows, or technicians). It
should be attached to the C.V. and submitted by the Principal Investigator at the time the
proposal is submitted to the IACUC for initial review or when an amendment is
submitted to add new personnel to the protocol. Please indicate the date of your last
tetanus inoculation below (if necessary, please verify with your physician). An
inoculation must be valid for the full three-year approval period of the protocol.
I________________________________________ certify that I received my last tetanus
(print name)
inoculation on__________________.
___________________________________________
Signature of Personnel
_________________
Date