The University of Mississippi Medical Center
Training Requirements Registration Form
IACUC - Institutional Animal Care and Use Committee
Telephone 601 815-5006 / Facsimile 601 815-5010
Training verification is an institutional responsibility to ensure that all personnel working with laboratory animals are
properly qualified. The Animal Welfare Act states that “Training and instruction shall be made available, and the
qualifications of personnel reviewed, with sufficient frequency to fulfill the research facilities responsibilities”. Further, the
Guide for the Care and Use of Laboratory Animals notes that “Investigators, technical personnel, trainees, and visiting
investigators who perform animal anesthesia, surgery or other experimental manipulations must be qualified through
training or experience to accomplish these tasks in a humane and scientifically acceptable manner”. Thus, satisfying the
training requirements of the institution may be achieved by numerous methods.
The UMMC IACUC has established four components to the requirements for training. ALL requirements MUST be
completed in order to obtain access into the LAF:
► Attendance of IACUC-sponsored Orientation Session: Quarterly the UMMC IACUC sponsors and conducts
orientation sessions addressing institutional and regulatory compliance issues, recordkeeping and reporting requirements,
educating personnel on policy and procedural changes, animal facility management topics, etc. Each individual working
with laboratory animals is required to attend one session within 90 days of hire.
► IACUC ON-LINE TRAINING: UMMC IACUC utilizes the Collaborative Institutional Training Initiative (CITI) for online
training. All principal investigators and all research staff are required to successfully complete the following on-line
training modules: 1) Working with the IACUC and one course pertaining to each species you work with. You are not
required to complete the Human Research module.
Steps to reach On-line training modules:
 Access homepage http://www.citiprogram.org
 Click on “Register Here”
 Select “University of Mississippi Medical Center” from the list of Participating Institutions
 This will assign you as a participant to the University of MS Medical Center.
 Follow the instructions.
 Answer Question 3 “LAB ANIMAL WELFARE” to select your courses (You may skip Questions 1 & 2 “HUMAN
SUBJECTS RESEARCH”).
 Select the box for the “Working with IACUC Course” and the box for each species your work involves.
 Complete required modules.
 Print the Completion Report and attach it to this form.
► LAF Tour participation is required to familiarize personnel with facilities they will use in the conduct of their study with
specific attention given to husbandry details related to the animal species. Tours are conducted Thursday at 2:00 p.m.
Contact the LAF business office (4-1385) to arrange your tour.
► Occupational Health & Safety Program - All employees must complete two (2) occupational health forms: 1) Animal
Exposure Worksheet, and 2) Health Screening Questionnaire. Forms are available at http://paws0.umsmed.edu/EOH/.
Forms must be completed on-line.
► If you have previously worked with animals at UMMC and completed the training requirements you do not have to
repeat the IACUC Orientation or the LAF tour. If you are working with the same species you do not have to repeat the online training. If your previous training cannot be verified, you will be asked to repeat the training.
All individuals working with live animals must be listed on an approved animal activities form (protocol).
Individualized training can be provided upon request. Please contact the LAF office to arrange additional training.
Revised: 14 July 2011
The University of Mississippi Medical Center
Training Requirements Registration Form
IACUC - Institutional Animal Care and Use Committee
Telephone 601 815-5006 / Facsimile 601 815-5010
A signed and dated hard copy of this form must be submitted to the IACUC office for each individual handling, caring for,
and using animals for research and teaching activities. The form will become part of the personnel’s training record.
Name: ____________________________________________________
UMMC Employee #: ____________________________
Department: _______________________________________________
Telephone ext: ________________________________
E-mail address: _____________________________________________________________________________________________
☐faculty ☐instructor ☐post-doc ☐ graduate student ☐ technician
☐student (list program ________________________________) ☐ other _______________________________________________
Occupational classification (check one):
Degrees attained (check all that apply): ☐PhD
☐ DVM ☐MD ☐ Masters ☐ Bachelor ☐ Associates ☐ High School/GED
Investigator whose laboratory you will work in: __________________________________________________________________
Species of animal(s) you will be working with:
☐Rat ☐ Mouse ☐ Rabbit ☐ Dog ☐ Pig ☐ Guinea Pig
☐ Cat ☐ Fish ☐ Nonhuman Primate ☐ Other _________________________
☐feeding/watering ☐ Handling/restraint ☐ Blood collection ☐ Injections (IM, IP, SC)
☐Surgery ☐ Post-surgical monitoring ☐ Euthanasia ☐ Other ______________________________________________________
Job duties (check all that apply):
☐No (complete #1 – 4 below)
☐ Yes – Are you working with the same species? ☐No (complete #2 for new species and 4 below) ☐Yes (complete #4 below)
Have you previously worked with animals at UMMC and completed the training requirements?
1. I attended an IACUC sponsored orientation training session on the following date:___________________________________
☐ I will attend the next available session.
2. I have completed the CITI courses:☐ Working with the IACUC
(print and attach Completion Reports)
☐ one course on each species I will be working with
3. I participated in a Laboratory Animal Facilities Orientation Tour on the following date: _______________________________
4. I have completed the Occupational Health & Safety forms:☐ Online
☐ Paper (attach Animal Exposure Form)
ATTESTATION: I am responsible for requesting and obtaining appropriate training on proper methods of animal care and handling and
any other animal procedures necessary for the conduct of this research or teaching activity. I am aware training can be requested and
provided by the LAF staff upon request.
Signature of named applicant: ____________________________________________________
Date: _________________
PRINCIPAL INVESTIGATOR’S ATTESTATION: I am responsible for assuring that the above named individual working on my project
(or in my animal area) is trained in the proper methods of animal care and handling and conducting this research or teaching activity. I
am aware training can be requested and provided by LAF staff upon request.
Please send a memo to the IACUC office adding the named personnel to your approved animal protocol.
Signature of Principal Investigator/Sponsor: ________________________________________
Date: _________________
Signature of IACUC Training Coordinator: _____________________________________________
Date: _________________
Revised: 14 July 2011
LAF Access: ____________
Entered in database: _______