22203 January2013
Ontario Veterinary College
Health Sciences Centre
Approval for the use of OVC HSC Isolation for Research
Project
Title
Principle
Investigator
Phone
Phone
Research
Technician Phone
Graduate
Student Phone
University of Guelph biosafety approval number:
AUP
Number
Microorganism
Animal Species
Indicate the isolation and barrier
precautions that are required for
routine management
Gloves
Gown
Overboots
Eye Protection
Respiratory protection (indicate type) ________
Will OVC HSC personnel
(technicians, kennel staff/agricultural
assistants, students) be involved in
patient care?
Yes
No
If yes, attach training and education plan for in-contact personnel
Will animals be moved out of
isolation for any procedure?
Yes
No
If yes, attach the written plan for where animals may be taken, how they are
transported and infection control practices that will be used.
Dogs: will dogs be allowed outside to
urinate or defecate?
No
Yes, in the designated high risk dog walking area
Yes, the normal dog walking area
Small animals: Will other clinical
cases be allowed in isolation at the
same time if required?
No
Yes, with individual case approval of infection control
Yes, with individual case approval of infection control and investigator
What practices are required for
terminal cleaning and disinfection?
Routine isolation practices
Enhanced practices: specify: ___________
Enhanced practice plus environmental testing: specify: ___________
_______________________________________ ________________________________________
Associate Dean, Clinical Programs Signature Date
________________________________________ ________________________________________
Chief of Infection Control Signature Date
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