Skip to Local Navigation
Skip to Content
California State University, Long Beach
Office of University Research
Print this pageAdd this page to your favoritesSelect a font sizeSelect a small fontSelect a medium fontSelect a large font
 

Maintenance and Animal Observation Form (rev. 9/10)

Download this form in Word. When finished, e-mail the form to the Attending Veterinarian, John Young, for review.  After his review, e-mail the form to iacuc@csulb.edu for placement on an IACUC meeting agenda.

(Note: This form must be typed; handwritten forms will not be accepted.)

IACUC Project Number:
  1. Responsible Faculty Member
    • Name:
    • Department:
    • Office Location:
    • Extension:
    • E-mail Address:
  1. Description
    • Provide a brief explanation and rationale for maintenance and observation of animals in classroom/office.
  1. Animal Information
    1. Species/Strain:
    2. Sex:
    3. Age/Size:
    4. Breeding Necessary: Yes ____ No ____
    5. Vendor Source:
    6. Number to be maintained:
    7. Animal Housing Location (Bldg/Rm):
  1. Animal Facilities
    1. Description of primary enclosure (housing unit for animals).
    2. Description of routine husbandry including frequency of activity (feeding, watering, cage sanitation, environmental temperature, etc.).
    3. Provisions for husbandry of animals during weekdays, weekends, holidays, vacations, etc.
    4. Provisions for veterinary consultation and/or euthanasia in the event of a health problem.
Signature and Date:

Back to top