Precautions for This Protocol (For Assistance, Contact OEH&S And/Or DLAR)

Animal Hazardous Agents Form – Part II Date last revised: It is the Principal Investigator’s responsibility to post the final version of this form on the lab/animal room door two weeks prior to start of protocol. Date Posted: Department: Protocol #:

Room: Building:

Campus Authorized Personnel Home Phone Pager/Mobile Phone Principal Investigator:

Authorized Personnel:

Precautions for this protocol (for assistance, contact OEH&S and/or DLAR)

Animal Species:

Type of Hazard

[ ] BSL 1: Biohazardous Agents: [ ] BSL 2: Check category and list agent(s) [ ] human cell lines or human tumors*:

Location of Biosafety Cabinet

Chemical Agents (including gas Estrogen pellets anesthetics)**: Radioisotopes**:

How long should precautions be [ ] 72 hours followed? [ ] Duration of project (Note: You must notify DLAR each time [x] Other: treat bedding as hazardous for 7 days these precautions should be instituted) [x] gloves [x] dust mask [ ] N95 respirator [ ] foot covers [ ] head cover/ bonnet [ ] safety glasses Protective Clothing: [ ] goggles [x] sleeves (while working in biological safety cabinet) [x] for lab/ research staff: gown or lab coat [ ] other: ______[ ] urine [ ] feces [ ] saliva Route of Animal Excretion: [ ] respiratory [x] none expected [ ] other:______[x] routine incineration [x] chemical waste Animal Carcass Disposal: [ ] biohazardous waste [ ] radioactive waste [x] other: carcasses stored in biohazard bag prior to incineration [ ] regular waste Biohazardous Caging/Bedding Disposal: [ ] autoclave then treat as regular waste Bedding: [X] regular waste [ ] chemotherapeutic/chemical waste Chemical or Radioactive Caging/Bedding [ ] radioactive decay [ ] radioactive waste Disposal: Caging: [x] regular waste [ ] autoclave then treat as regular waste Surface and Equipment Decontamination [ ] autoclave [ ] bleach [ ] Spor-Klenz [ ] quat. ammonia compound [X] regular cage wash procedure [ ] radioactive decay [ ] other: [x] any of the above marked options ______Note: avoid using bleach on stainless steel surfaces (biosafety cabinets) [ ] room pressurization negative to corridor Animal Handling Precautions: [ ] biological safety cabinet used for cage changes and animal handling (req. for BSL 2)

Additional Precautions:(e.g.: Overexposure may be toxic to kidney, liver, cardiovascular system, and immunizations, restricted access, special central nervous system. No significant exposure is expected, as small decontamination, specific waste disposal, estrogen pellets (1.7ug; 60 day release) are subcutaneously implanted at the etc.) back of the mouse’s neck. **NOTE: Individual cages must be identified with the hazardous agent, date of administration and appropriate chemical hazard label. 1. My staff and I will comply with all standards for animal care and investigation established in the Guide for the Care and Use of Laboratory Animals and the Federal Animal Welfare Act, and will follow all policies established by the University to assure that these standards are met. 2. I assume responsibility for the work described here. 3. All individuals working with the animals on this protocol are qualified by virtue of training or experience to perform proper handling, experimental, and restraint techniques required for the species to be used. 4. I recognize my responsibility to identify occupational health hazards related to this protocol including identifying hazards, providing the necessary training for those involved, and supplying the appropriate protective clothing and equipment to minimize the risks. 5. This research does not represent unnecessary duplication of previous experiments. 6. I realize that failure to adhere to policies related to animal care and use may result in suspension or revocation of permission to perform animal research in Wayne State University facilities. 7. For more information please read the safety standard operation procedures (SOPs). The PI and OEHS will maintain a copy of the SOPs.

Signature of Principal Investigator Date (must be original; no copies, image files, etc.) Approval Date (to be filled in by OEH&S):