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UConn Health Initial Animal User Training Request

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UConn Health Initial Animal User Training Request

If you will be participating in laboratory animal work at UConn Health in Farmington, please complete this form. Please fill out the form completely. Incomplete forms will be returned and training will not be scheduled.

Contact Information
Name*
First Middle Last
Department*
Job Title*
Job Type
This field is hidden when viewing the form
UConn Health Network Account Username
Enter your UConn Health Active Directory domain network account username that is used to login to the UCH network and computers. DO NOT ENTER THE PASSWORD! Just the username.

Don't have a UCH network account username? Have your Principal Investigator or Department Administrator request one via an on-campus computer at https://uar.uchc.edu. All UConn Health employees and students have a network account but it must be manually requested for vendors, external affiliates (e.g. Jackson Lab employees, TIP employees), volunteers, student interns, UConn Storrs students, and some temporary special payroll employees. All animal users must have a UCH network login to register for training and gain access to Topaz Elements. Please come back and register after you obtain this username if you do not have one currently.
NetID*
Enter your UConn NetID.
If you do not know what your UConn NetID is, you can look it up at this location: https://netid.uconn.edu/find_netid.php
UConn Health (UCHC) Email:*
If you do not have a UCHC email address, work with your dept. administrator to obtain one.
Enter Email Confirm Email
Phone
Other Email Address
Enter your company email address if other than UCH, such as a TIPS company or Jax lab.
Enter Email Confirm Email
Date of Birth*
Month
Day
Year
Gender*
Highest Degree*
Select the highest degree you have obtained.
What is the name of the Principal Investigator (PI) that you will be working with?*
Initial IACUC Training
Training Session Date Requested*
Refer to the IACUC Training Schedule for a listing of training dates.
Month
Day
Year
Skills and Experience
What species are you going to use?*
- Birds
- Cats
- Chinchillas
- Fish
- Gerbils
- Guinea pigs
- Hamsters
- Mice
- Rats
- Nonhuman primates
- Not sure
- Other
Other Species to be used
Create a new line for each species. Click the + sign to add a new row.
What procedures are you likely to use on animals?*
- Handling
- Injections
- Euthanasia
- Survival surgery
- Husbandry
- Non-survival surgery
- Post-procedural monitoring
- Use of restraints
- Unknown
- Other
Other Procedures Likely Used
Enter each procedure as a separate line. Click the + sign to add a new row.
Will you be using hazardous substances when working with animals?*
- No
- Not sure
- Yes
Hazardous Substances to be used
Enter each substance on a new line and then click the plus sign to add another hazardous substance row. Repeat as needed.
Have you had any previous training in the use of laboratory animals?*
- No
- Yes
Prior Animal Training Experience
Dosing
List each technique. Examples include IV, IM, SC, IP, PO FP, or IC. Click the plus sign to add additional rows as needed.
Method Experience in Years Species Institution Where Training Occurred Date Training Completed
Handling & Restraint
Experience in Years Species Institution Where Training Occurred Date Training Completed
Animal Identification Methods
List each method. Examples include ear punch, ear tag, chip implant, tattoo, toe clip, or branding. Click the plus sign to add additional rows as needed.
Method Experience in Years Species Institution Where Training Occurred Date Training Completed
Blood Collection
List each type. Examples include IV, Saphenous, RO, Tail Nick, or Cardiac Puncture. Click the plus sign to add additional rows as needed.
Method Experience in Years Species Institution Where Training Occurred Date Training Completed
Anesthesia
List each method. Examples include injectible or inhalation. Click the plus sign to add additional rows as needed.
Method Experience in Years Species Institution Where Training Occurred Date Training Completed
Euthanasia
List each method. Examples include CO2, Cervical Dislocation, Decapitation, Injectible, or Pithing. Click the plus sign to add additional rows as needed.
Method Experience in Years Species Institution Where Training Occurred Date Training Completed
Aseptic Surgery Technique
Experience in Years Species Institution Where Training Occurred Date Training Completed
Other Surgical Procedures
List training using different surgical procedures. Click the plus sign to add additional rows as needed.
Name of Procedure Experience in Years Species Institution Where Training Occurred Date Training Completed
Personal Agreement
- • I will perform my duties in accordance with the Animal Welfare Act, the USDA regulations, the PHS Policy on Humane Care and Use of Laboratory Animals, the current AVMA Guidelines on Euthanasia, and the current Guide for the Care and Use of Laboratory Animals.
- • I will review the protocol(s) under which I will be performing work and will be responsible for conducting this work as it is stated in the IACUC approved protocol.
- • I will ensure that IACUC approval has been received before conducting any procedures not listed in the original protocol(s).
- • I will immediately notify the attending veterinarian, my Principal Investigator (PI), and the IACUC when any unanticipated animal pain/distress or unexpected morbidity/mortality occurs within any of my studies.
Certification*
- I have read the above and agree to the terms
Name
This field is for validation purposes and should be left unchanged.

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Method	Experience in Years	Species	Institution Where Training Occurred	Date Training Completed

Name of Procedure	Experience in Years	Species	Institution Where Training Occurred	Date Training Completed

UConn Health Initial Animal User Training Request

Contact Information

Initial IACUC Training

Skills and Experience

Prior Animal Training Experience

Personal Agreement