APPENDIX A: Room/Lab Safety Sheet (RLSS) Information
1. List agent, materials, biohazard, or chemical to be used in animals:
Click here to enter text.
2. Provide short description of the agent, material, biohazard, or chemical:
Click here to enter text.
3. The agent, material, biohazard, or chemical is HAZARDOUS for:
☐ - Animals
☐ - Humans
☐ - Both
If animals is checked, for which species?
4. The agent can be spread by:
☐ - Blood
☐ - Feces/Urine
☐ - Saliva/Nasal droplets
☐ - Does not leave the animal
☐ - Other – please describe: Click here to enter text.
4. Describe any human health risk associated with this agent: (i.e.: effects of overexposure, eye contact,
skin contact, inhalation, ingestion, target organs, etc.)
Click here to enter text.
6. Please check the precautions below that will apply to this protocol:
a. The following items must be assumed to be contaminated with hazardous material and must be
handled only by the researcher or his/her technicians:
☐Cage/Pen/Stall/Tank
☐Animal carcasses
☐Bedding
☐Water bottle or other watering device
☐Other – please describe:Click here to enter text.
b. ☐Cages must be autoclaved before cleaning
c. ☐Label cages and remove label after decontamination
d. Animal carcasses must be labeled and disposed of as follows:
☐ Standard animal facility disposal method (i.e. Biohazardous waste containers for Stericycle
pick-up)
☐ Needs to be bagged and autoclaved prior to removal from animal facility
☐ EH&S will pick-up (2-1493)
☐ Incineration
U: Drive/IACUC/SharedDocuments/Form Templates
Page 1
e. All contaminated waste (soiled bedding or other animal waste) must be properly labeled and
disposed of as follows:
☐ Standard animal facility disposal method (i.e. Biohazardous waste containers for Stericycle
pick-up)
☐ Needs to be bagged and autoclaved prior to removal from animal facility
☐ EH&S will pick-up (2-1493)
☐ Incineration
f. The researcher or his/her technicians are responsible for the feeding and care of these animals.
YES ☐ NO ☐
7. Please check the following Personal Protective Equipment required to be worn/used in animal room:
☐ Lab Coat/Coveralls
☐ Shoe Covers/Booties
☐ Disposable gloves
☐ Head cover
☐ Face mask
☐ Disinfectant footbath
☐ Eye Protection/Face shield
☐ Fitted respiration – Type: Choose an item.
☐ Other – please describe: Click here to enter text.
a. ☐ Personal protective equipment must be removed before leaving the room
b. ☐ Personal protective equipment must be discarded or decontaminated at the end of the project
c. ☐ Hands and arms must be thoroughly washed upon leaving the room
d. ☐ Full shower, including washing of hair, must be taken upon leaving the room
e. ☐ Decontaminate room (Inform vivarium area supervisor when cage and/or room can be returned to
general use)
8. Provide any other information needed to safely work in this room:
Click here to enter text.
U: Drive/IACUC/SharedDocuments/Form Templates
Page 2