Rhode Island Hospital Central Research Facilities

RHODE ISLAND HOSPITAL CENTRAL RESEARCH FACILITIES LIFESPAN AFFILIATE ANIMAL TRANSPORT REQUEST FORM REQUEST MUST BE MADE AT A MINIMUM OF THE DAY BEFORE THE TRANFER IS NEEDED. (Please return the completed form Central Research Facilities: FAX (401) 444-4195)

Is this transfer also a request to change ownership of these animals? Yes  No  If YES, please fill out an Animal Transfer Request form.

Date: Date of Transport: Transporter Information Time for transport: PI Name: Driver Name: Lab member or CRF member must accompany the transport. Contact: Lab/CRF member Name:

Phone No: Cell Phone No:

Protocol No:

DESTINATION Facility: Room Number:

ORIGIN The investigator sending animals must identify the cages to be moved. Facility: Room No: No. of Cages: No. of Animals:

Animal ID: Animal ID: Animal ID: Animal ID: Animal ID: CRF USE ONLY APPROVED  DISAPPROVED 

SIGNATURE: ______DATE: ______

Delivered by: ______Date: ______Time: ______

Received by: ______Date: ______Time: ______

Animal care staff: Transfers between RIH/Brown facilities should be performed in Jax or Taconic Shipping Crates or similar barrier equipment and should be decontaminated on arrival at the receiving facility. (alh 13)