UC Santa Cruz – Institutional Biosafety Committee (IBC) Transgenic Animal Registration Registration of the following must be submitted and approved by the IBC prior to creation of these animals: Generation of all transgenic animals (other than rodents that can be housed under Biosafety Level (BSL1) containment conditions). Generation of transgenic rodents requiring BSL2 or higher containment (e.g. those created with the use of certain viral vectors, or those that may express harmful proteins). Breeding of two different strains of transgenic (including knock-out*) animals, including rodents, where one or both animals require BSL2 or higher containment. Registration of the following may be submitted to the IBC concurrent to creation of these animals: Experiments involving the creation of transgenic rodents that can be housed under Biosafety Level 1. Breeding of two different strains of transgenic (including knock-out*) animals, including rodents, that requires BSL1 containment. * The techniques used initially to create knock-out animals involve the stable introduction of recombinant DNA into the animal’s genome, and thus these animals are considered transgenic under the NIH Guidelines. Please note: The purchase or transfer of transgenic rodents that may be maintained at BSL1 containment are exempt from the NIH Guidelines; however, no other animals are exempt (including phylogenetically lesser species). UCSC Transgenic Animal Registration Page 1 of 3 09/2009 Principal Investigator and Contact Information Responsible Faculty/PI: Principal Investigator: Division and Department: UC Employee ID: Address/Mail Code: Office Phone: E-Mail: Lab Extension Emergency/Home Phone: Fax: You must have at least one alternate contact that can respond to an emergency, answer questions for the Committee or an Inspector and/or will always be able to contact you. Alternate Contact: (Preferably an SRA, Lab Manager or Co-PI – Someone with responsibility for the lab who is informed of the research protocols and emergency response procedures) Lab Contact Job Title: Division and Department: UC Employee ID: Address/Mail Code: Office Phone: E-Mail: Lab Extension Emergency/Home Phone: Fax: By signing below, I certify that I have read the following statements and agree that I and all listed participants will abide by those statements and all UC policies and procedures governing the use of recombinant DNA as outlined in this registration and in the following: NIH recombinant DNA Guidelines (http://www4.od.nih.gov/oba/rac/guidelines/guidelines.html) Signature of Principal Investigator: UCSC Transgenic Animal Registration Date: Page 2 of 3 09/2009 Genetically Modified Animals List EACH animal separately: Spell out acronyms or abbreviations If the transgenic animal poses a known hazard, animal containment may need to be reassessed. Contact Biosafety x9-3542 or email biosafety@ucsc.edu for risk assessment assistance. DO NOT LIST NATURALLY OCCURRING/SPONTANEOUS/CHEMICAL OR RADIATION INDUCED MUTATIONS. Animal Species Gene Name and function UCSC Biological Use Authorization Biological Source of Gene Page 3 of 3 Type Source of Transgenic Animal Hazard Knockout PI's Lab No known hazard If other specify: If other specify: If other specify: Knockout PI's Lab No known hazard If other specify: If other specify: If other specify: Knockout PI's Lab No known hazard If other specify: If other specify: If other specify: Knockout PI's Lab No known hazard If other specify: If other specify: If other specify: Knockout PI's Lab No known hazard If other specify: If other specify: If other specify: December 2007 If a hazard exists, describe precaution for animal handlers and housing