Department of Animal Sciences, Wooster

Livestock Use Request

Department of Animal Sciences, Wooster

Part I. To be filled out by investigator before initiation of experiment/course.

Livestock Unit: ______

Principal Investigator

Name:

Address:

Phone (work):

Phone (home):

Fax:

e-mail:

Other Investigator(s)

Name: Name:

Address: Address:

Phone (work): Phone (work):

Phone (home): Phone (home):

Fax: Fax:

e-mail: e-mail:

Project Number (if applicable): ______

Animal Use Protocol Number if applicable: ______

  Not Applicable

  Pending

Project Title: ______

Objectives of Project: ______

______

______

Start Date of Study: ______

End Date of Study: ______

Number of Animals: ______

Sex/Age/Weight/Stage of Production (if applicable): ______

______

Treatment(s) to be imposed on these animals and number within each group. Indicate whether the treatment imposed will require disposal of the milk, eggs, or animals other than for meat. Give details as to the required withdrawal period(s) of treatment(s) if applicable:

______

______

______

______

Describe any special housing or handling requirements: ______

______

Describe data collection procedures and list who will be responsible: ______

______

______

Potential effects to the animal(s) resulting from the experiment, and clinical signs that require additional animal observation, treatment or removal from the study: ______

______

______

______

Do the potential effects of the experiment and clinical signs noted require notification of the PI? (Some? All? Please explain) ______

______

______

Feed/labor requirements unique to the project – if this project will incur additional labor and/or animal costs, give budget account number ( ______):

______

______

Prior to initiation of the experiment/course, following completion of Part I, the following signatures must be obtained, indicating agreement to the above terms.

Principal Investigator: ______Date: ______

Livestock Unit Manager: ______Date: ______

Livestock Unit Faculty Supervisor: ______Date: ______

Part II. To be filled out by the manager of the livestock unit.

Cost of additional labor and or feed described in Part I above: ______

______

______

______

The Principal Investigator and the Livestock Unit Manager should retain a copy of this final report. The original should be given to the Department of Animal Sciences fiscal officer to accomplish the transfer of funds (if any) to the Livestock Unit Earnings Account.

Research costs of animals, Wooster, v7.doc March, 2009