D IVISION OF R ESEARCH
IACUC
Name:
Title:
Location/Lab:
Description of
Duties:
PI:
Department:
Start Date:
I have received instruction in or completed the following:
1.Protocol Modification (For PI ONLY)
A protocol modification, adding the individual identified above, has been submitted to the IACUC for review, prior to the individual engaging in the care or use of animals.
2. Read the Clarkson University Policy on Research with Animal
Subjects at http://www.clarkson.edu/dor/compliance/animal_subjects.html
3.
CITI Program On-line Training Course “Working with the IACUC” at http://www.clarkson.edu/dor/compliance/animal_subjects.html
.
4.
CITI Program other species specific modules ( list below ):
Trainee
Initials
Trainer
Initials
Date
Completed
5.
IACUC Protocols/Laboratory Procedures
Read and understand the following p rotocols/laboratory procedures and have received training for the specific tasks I will be performing under these protocols:
Protocol#:
Protocol Title:
Specific Laboratory Procedures (when applicable):
6.
Orientation Seminar
I have participated in a orientation seminar, which discusses the laws and regulations covering laboratory animal care and use, emphasizing the contents of the NRC Guide and the 3R’s. Training included instruction on research or testing methods that minimize the numbers of animals required to obtain valid results and limit animal pain or distress as well as other requirements, as applicable, that are delineated in 9 CFR, Part 2, Subpart C,
Section 2.32(c).
Animal Care and Use Personnel Training and Orientation Record
Last Revised: 10/28/11

I have received instruction in or completed the following:
1.
Occupational Health Risk Assessment
I discussed the following with the Principal Investigator or designee: a. Nature of exposure; b. Any associated risks and hazards, when applicable;

Zoonoses (i.e. Mycobacterium, Salmonella)

Animal bites and scratches

Animal allergens (i.e. sensitivity to fish proteins, sea food allergy, hair, dander)

Chemical hazards


Physical hazards (i.e. slips, trips, or falls)
Biological hazards

Radioactive hazards c. Procedures in place to alleviate hazards and minimize risks, when applicable

Proper animal handling techniques


Personal protective equipment (PPE) requirements
Personal hygiene requirements

Hand washing after handling animals or related equipment

Use of disposable supplies whenever possible

Sanitizing lab work areas after animal work

Specific procedures for the treatment and reporting in the event of bites, scratches, illness or injury.

Chemical hygiene plan and material safety data sheets are located
_______________________________________________.
(identify location) d. Drugs and medical conditions that may place me at increased risk, including but are not limited to steroid, allergies, cancer, chronic diseases, pregnancy, surgical procedures, and deficiencies of the immune system; and e. Additional training requirements, if necessary.
Trainee
Initials
Trainer
Initials
Date
Completed
2.
Physical Examination
A complete physical examination by a personal physician was recommended to me prior to being involved in animal care and/or use of laboratory animals and once on an annual basis. I was encouraged to discuss with my personal physician the occupational health risk assessment; specifically discussing the nature of exposure, common associated risks and hazards, and procedures in place to alleviate those hazards and minimize risks, and ways to reduce the risk associated with any existing medical conditions or medications that may place me at increased risk.
3.
Immunizations
Principal Investigator, or designee, discussed the following with me:
Personnel directly involved with animals are recommended to have a current tetanus vaccination (within 10 years). Other immunization recommendations are on a case-by-case-basis, if needed (list below):
Student workers are referred to the Student Health Center and employees are referred to their personal physician for recommended immunizations.
Animal Care and Use Personnel Training and Orientation Record
Last Revised: 10/28/11

Trainee
Initials
Trainer
Initials
Date
Completed
I have received instruction in or completed the following:
4. Bites, Scratches, Illness or Injury
I am aware that in the event of bites, scratches, illness or injury basic first aid kits are readily available in all animal care facilities and laboratories where animals are utilized and on-site during field studies. Students and employees requiring medical attention are sent to the Student Health Center or to their personal physician, respectively. If injury or illness is serious, or after business hours, individuals are sent to the local hospital emergency room for treatment. For life threatening injuries, 911 is immediately called.
All work related injuries and illnesses must be reported to the Animal
Facility Manager and the Office of Risk Management.
5.
Environmental Health and Safety Training
I am aware of the following training requirements, as determined by the Principal Investigator and/or the
Environmental Health Manager (check required below) :


Laboratory safety training is required for all animal care and use personnel.
Biosafety training is required when working with biological materials (Examples include, but limited to: animal cells, tissues, blood or blood products; human source materials; infectious agents; or recombinant
DNA technology) Contact Environmental Health and Safety for additional guidance.

Radiation training is required when working with radioactive materials.
Principal Investigators or Trainees should contact Environmental Health and Safety to schedule training or to seek assistance in determining appropriate training requirements.
Laboratory Safety Training
Biosafety Training
Radiation Safety Training
______________________________________________
______________________________________________
Trainee
Initials
Trainer
Initials
Date
Completed
D. QUESTIONS AND CONCERNS INVOLVING CARE AND USE
OF ANIMALS
I have received instruction in the following:
Any concerns are important to Clarkson University. Any individual may ask questions or report concerns involving the care and use of animals to the Institutional Officer, IACUC Chair, Institutional Veterinarian,
Research Compliance Officer, or any member of the IACUC. Any individual, who in good faith, reports an animal welfare concern, will be protected against reprisals. Additionally, any individual may use the
University privacy hotline to report a concern.
Trainee
Initials
Trainer
Initials
Date
Completed
Animal Care and Use Personnel Training and Orientation Record
Last Revised: 10/28/11