Fillable IACUC Lab Inspection Form - lab_animals_inspection_form

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IACUC Lab Inspection Form - lab_animals_inspection_form

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ICCULAE Laboratory Inspection Form| Page 1 of 2
TENNESSEE TECHNOLOGICAL UNIVERSITY
Office of Research
Institutional Committee for the Use and Care of Laboratory Animals in Experimentation
Laboratory Inspection Form
Date of Inspection: _____________________ Veterinary Support ______________________
IACUC Team: ______________________
______________________
General Use of
Animal Subjects in
Lab:
______________________
______________________
Laboratory: ______________________ Location: ______________________
Lab Supervisors: ______________________
Offices: ______________________ Telephone: ______________________
Species Housed No. of
Cages
Cage Size
(inches)
Max.
Animals Per
Cage
Duration of
Housing
1 ____________________________ ______ ___________ ___________ ___________
2 ____________________________ ______ ___________ ___________ ___________
3 ____________________________ ______ ___________ ___________ ___________
4 ____________________________ ______ ___________ ___________ ___________
5 ____________________________ ______ ___________ ___________ ___________
6 ____________________________ ______ ___________ ___________ ___________
Type of Bedding Freq. of
Cage
Cleaning
Disinfectant
Employed
Food or Water
Resource
Frequency
of Animal
Inspection
1 ______________________ __________ __________ _______________ ________
2 ______________________ __________ __________ _______________ ________
3 ______________________ __________ __________ _______________ ________
4 ______________________ __________ __________ _______________ ________
5 ______________________ __________ __________ _______________ ________
6 ______________________ __________ __________ _______________ ________
ICCULAE Laboratory Inspection Form| Page 2 of 2
1. Description of painful or stressful procedures:
2. Description of use of analgesics or anesthetics:
3. Euthanasia practices:
4. Carcass disposal practices:
SECTION BELOW FOR INSPECTION COMMITTEE USE ONLY
Environmental Ratings
Excellent Fair Good Poor
Ventilation _____ _____ _____ _____
Cold Control _____ _____ _____ _____
Heat Control _____ _____ _____ _____
General Sanitation _____ _____ _____ _____
Cleanliness of Cage _____ _____ _____ _____
Security of Food Supply _____ _____ _____ _____
Cleanliness of Water Supply _____ _____ _____ _____
Separation of Species _____ _____ _____ _____
Immediate Deficiencies:
Long Term Recommendations:
Signatures of Inspection Committee: 1. __________________________________________
2. __________________________________________
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IACUC Lab Inspection Form - lab_animals_inspection_form

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Completed 14 March 2020

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