ANIMAL REQUISITION FORM (CMG 90)
Comparative Medicine Group
College of Veterinary Medicine

Protocol # _____________________

Department ____________________

Project duration _________________

 

 Investigator _____________________________

Phone #   _______________________________

Emergency phone # ______________________

Order Specification:

Vendor _________________________   Substitution acceptable?___________________

Species _________________________ Terminal or nonterminal ___________________

Number ___________ Age ___________ Sex ______________ Breed _________________  Size___________________


Delivery and Housing Instructions:

Delivery date ________________________

 Building and room number __________________

Inside___________ Outside_________		 Group_____________ or Individual ___________

In case of sickness or death, notify: ______________________________________________________

BIOSAFETY:

Will animals or humans associated with the project be exposed to infectious agents, biohazards, radioactive materials, toxins, or other types of hazards?**
If yes, what is the nature of the exposure?

**Must be approved by the Director of CMG prior to initiating study to insure that proper training and safety precautions are in place.

Ancillary services:

Fund Director ________________________________________ Date_______________________

Department Head_____________________________________ Date _______________________

CMG Director _________________________________________Date _______________________

An approved IACUC protocol and, if required, an IBC Registration Document must be on file in the CMG Office prior to ordering animals.