Name:
Title:
Work Location:
PI:
Department:
A. I have:
1. Submitted my Occupational Health forms to Occupation Health Program through Environmental Health Services
B. I have attended the following courses or received instruction in:
1. The Ethical Care and Use of Animal Subject through RICRO
2. Introduction to the IACUC and RICRO (on-line exam)
3. Animal Handling and Restraint
4. IBC Training
5. BSL2 training
6. BSL3 training
7. Aseptic Surgical Technique
Initial Trainer Date
C. I have received training/information on the following: Trainer Date
1. Animal Bite Instructions ( Must be reported to supervisor)
2. Incident reporting
3. The emergency action plan for my work area
4. Potential zoonotic diseases which I may be in contact in my work area.
Including:
5. Notification of my responsibility to contact my supervisor for training/information before I perform any task for which I am not trained
6. Personal hygiene in the workplace
7. Location of the emergency shower & eye wash
8. Aseptic technique
9. Animal records with regard to pre-, peri-, and post-op monitoring
10. Animal carcass disposal and handling
11. Identifying pain and discomfort in the animal(s) I am working with
12. Anesthesia monitoring
13. Cold sterilization procedures
14. Safe Handling of anesthetic gases including scavenging procedures
15. Controlled drug records and requirements
16. Chemicals in the lab and location, content and use of the Material Safety Data
Sheets (MSDS’s)
17. Animal handling and husbandry
18. Reporting Animal Care and Use Concerns
19. Blood born pathogen training
20. Autoclave usage
21. Aerosol chamber usage
22. Biosafety cabinet training
23. Chemical safety and disposal training
24. Proper sharps handling
Revised May 2010

D. I have read and understand the following Animal Care and Use Protocols on
which I will work with animals:
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E. I have received the following protocol specific training (i.e. surgical
techniques, euthanasia methods, injection techniques, etc.):
1.
Initial Trainer Date
Initial Trainer Date
Revised May 2010