Training Confirmation Form 2

AnesthesiaSpecify agent, route& dose reviewedwith usersDepth of anesthesiaPost proceduremonitoringVaporizer MachineUse (if applicable)Methods trained on:Isoflo handout and chamber cleaning proceduresAnalgesiaRecordkeepingSpecify agent, route& dose reviewedwith usersEuthanasia(circle all that apply)CO2Cervical dislocationDecapitationDrug overdose(specify agent, route &dose reviewed with user)Major surgery training:survival and nonsurvival(if applicable)Policy reviewedSecondary MethodsSERI Rodent Euthanasia PolicyNumber of euthanasias observed:Methods trained on:Number observed:Surgery training:(if applicable)Sterile glovingAnimal prepNumber observed:Survival proceduretraining: (if applicable)Number observed:Miscellaneous animalproceduresTissue collection forgenotyping orphenotyping (bleeds)Breeding set upsBreeding ratiosMethods trained and observed:Policies reviewed User Initials: Reporting Animal DeficienciesMultiple Major Survival SurgeryPhysical Restraint PolicyAnimal Facility Visitor PolicyAcclimation and Stabilization PolicyRodent Surgery Policy

SOP’s reviewed User Initials: Animal ImportsAnimal ExportsAnimal TransfersEquipment Use:Glass bead sterilizersCirculating hot waterblanketsMicrowave padsFume hood & ductlessfume hoodTissue collection for genotyping (tail snips/ear snips)Facility Tour &GuidelinesRoom order of entrySigning out procedureareasCarcass disposalClean vs dirtyAnimal Facility WebsiteEmergenciesAccidentsHealth & SafetyLocation of emergency numbers, eye wash stations,safety showers, first aid kits, other:Reporting accidents.PPE’s, bite and scratch procedures. Do not recap needles,other:Hazard/SASP Training List all SASPhazards trained on:SASP #’s reviewed:USER INITIALS:Hazards listed in IACUC protocol (s): ___________________________________________________________________________________________________________Inititals: ______OEHN CLEARANCE GIVEN ON: _______________________Animal Facility Access given on: ________________________Inititals: ______Inititals: ______Rev. JAN 2010