Surgery Observation Registration — Institutional Animal Care and Use Committee

Attendee Information

First Name

Last Name

Your E-Mail Address

Phone Number

Employee ID

IACUC Protocol # List protocols you are approved on

Species Indicate the species approved in your protocols

Mouse

Rat

Both Mouse and Rat

Other (Contact IACUC Office)

Name of Surgical Procedure(s) List name of surgical procedure(s) to be observed

Are these Survival or Non-Survival? If you will do both, please select Survival.

Survival (the animal will recover from anesthesia)
Non-survival (the animal will NOT recover from anesthesia)

Surgical Experience Only experienced surgeons qualify for surgical observation. Please describe your years of experience performing rodent surgery.

Location

Surgeries will be observed in the standard area they are to be performed by the surgeon (e.g., lab space, procedure room).

Facility Name

Room

Upcoming Surgery Dates & Times Surgery must be observed from the beginning of prep through closure.

Other Comments