CONTAINMENT HOUSING REQUEST
FORM
Part I
Investigator Name
Investigator Contact Information
Protocol Number
Protocol Expiration Date
Name of Person to Contact for More Information
About This Request
Contact Email Address
Contact Telephone Number
Animal Containment Housing Location
Part II
Hazardous Agents Being Used:
Animal Biosafety Level
Part III
Names of All Laboratory Personnel Requiring Access to Containment Housing Space: CHECK
THE BOX NEXT TO YOUR NAME IF YOU HAVE TAKEN THE CONTAINMENT TRAINING COURSE
Name:
Phone Number:
Email Address:
Part IV
Species Being Used
Date Animals Will Be
Placed in Containment
Housing Area
Number of Cages:
Containment Housing Room (Assigned by
Husbandry Supervisor)
Date Hazardous Agent Will
Be Administered to Animals
Date Animals Are No Longer Hazardous
and May Be Removed From
Containment Housing