Principal Investigator:
Protocol # (if available):
Date:
PERSONNEL QUALIFICATIONS FORM (PQF)
All PIs and personnel handling animals are required to complete the Animal User training course and
enroll in the Occupational Health & Safety Program for Animal Handlers. Animal User training refresher
course is required every three years. Training must be complete prior to approval of protocol or personnel
addition. The Principal Investigator is directly responsible for the conduct and performance of all
individuals working on an approved protocol, which includes providing all necessary training for an
individual to be competent in all techniques and procedures conducted on animals. Submission of this form
indicates that the person listed above will be trained appropriately by the PI or the PI’s designee.
1. Personnel Information
a. Name
b. Email Address:
c. UMCP RELATIONSHIP Mark an “X” in applicable box:
Faculty
Staff
Post-doctoral
Graduate Student
Undergraduate Student
Visiting Scientist
Off-campus Associate
Other:
d. ANIMAL CONTACT* Mark an “X” in applicable box:
WILL NOT have animal contact.
WILL have animal contact. Complete remainder of this form (All PIs must complete form.)
Took the PI/Animal User course on:
(month/day/year)
Took the refresher Training course on:
(month/day/year)
Will perform the following animal care activities - Mark an “X” in applicable box(es):
Animal Care / Husbandry
Injections/Minor Procedures
Anesthesia
Euthanasia
Surgical Procedures
Tissue Harvest
1
2. SKILLS & TECHNIQUES Mark an “X” where applicable – technical skills listed should be
applicable to those needed for this protocol only.
Training on specific procedures may be arranged through the Central Animal Resource Facility
(CARF) or the Department of Environmental Safety (DES). Documentation of laboratory-specific
training (e.g, surgery, experimental procedures, emergency plan), including date of training and
name of trainer, should be available in the lab/facility during semi-annual inspections.
Species 1
Species 2
Species 3
Identify species:
Current
Skills
Training
Needed
BSL2/BSL3 Containment (DES)
Radiation Safety (DES)
Husbandry
Handling & Restraint
Bedding & Cage Change
Identify Trainer(s):
Anesthesia
-
Injectables
-
Inhalants
Identify Trainer(s):
Injections
-
Intradermal (ID)
-
Intravenous (IV)
-
Intramuscular (IM)
-
Subcutaneous (SQ)
-
Intraperitoneal (IP)
-
Intracardiac (IC)
-
Intraorbital (IO)
-
Intranasal (IN)
-
Intratracheal
2
Current
Skills
Training
Needed
Current
Skills
Training
Needed
Current
skills
Training
Needed
Blood Collection
Tail Vein
Jugular Vein
Wing Vein
Saphenous Vein
Orbital Sinus
Cardiac Puncture
Cutdowns
Identify Trainer(s):
Oral gavage
Identify Trainer(s):
Euthanasia
CO2
Inhalants
Injectables
Decapitation
Cervical Dislocation
Perfusion
Pithing
Identify Trainer(s):
Surgical Technique(s) Identify below:
1.
2.
3.
Aseptic Technique
Post-Surgical care
Identify Trainer(s):
Other Technique(s) - Identify below:
1.
2.
3.
Identify Trainer(s):
3
Current
skills
Training
Needed
Current
skills
Training
Needed