/ UNIVERSITY OF TOLEDO
RESEARCH SPONSORED PROGRAMS /
RSP430 (6/08)

CHANGE IN AUTHORIZED PERSONNEL: PROTOCOL AMENDMENT FORM

Instructions: 1) Please type the information. This form is available at . 2) A separate form is necessary for each protocol and each person to be added to the protocol. 3) Submit completed form to the IACUC Office.

P.I. Name: / Date of Request:
IACUC Protocol #:
IACUC Protocol Title:

Please complete items 1-5 below for the person to be added to the protocol. To delete personnel, enter the name, check “Delete” in #1 and answer #6. See next page for further instructions and web page links.

1) Personnel Information / 2) Protocol procedure to be performed / Experience
Name: / 1) / Years
Role on Project: / Grad. Research AssistantCo-investigatorResearch AssociateTechnicianUndergraduate Student / 2) / Years
Rocket # Required): / R / 3) / Years
Add or Delete? / Add Delete / 4) / Years
UT Status: / Registered StudentStaff/EmployeeFacultyRegistered Volunteer / 5) / Years
3)What species will this individual be handling?
4)If this individual has no previous experience in any of the procedures and/or species listed, for each procedure, describe how s/he will be trained and who will administer and monitor the training. Describe other relevant experience too.
NOTE: Summer students and rotation students should only work with live animals under direct supervision.
5)Has this individual: (a) Viewed all appropriate IACUC training tapes?
(b) Filed an appropriate Exposure Profile with the Safety and Health Department? / YesNo
YesNo
An Exposure Profile may be filed at the following web page:
NOTE: Addition of personnel will not be approved before completion of 5(a) and 5(b).
6)If this individual is key to the project and to be deleted from the protocol, please indicate who will take over his/her responsibilities.

Signature of Principal InvestigatorDate

UT IACUC Use Only:

PROTOCOL PERSONNEL ADDITION(S) APPROVED / DELETION(S) NOTED

Signature of Chair/Vice Chair, IACUC / Date / Required Training Tapes / Training Completed

Z:\ResearchAdmin\RSP\Hsc\FORMS\REGCOMP\IAC\rsp430.docRevised: 06/2/2008

INSTRUCTIONS: Change in Personnel

This form assists the PI in providing the IACUC with the necessary information to allow addition of new personnel or removal of existing personnel to an animal use protocol. The IACUC has approved the use of an expedited review process that should speed up the approval process. The IACUC training tapes are available in the Animal Facility.

1)The current version of the form is available on the RSP web page

2)Please type information on the form and use drop-down boxes where present.

3)Since copies must be kept in the file with the relevant protocol, a separate form is necessary for each protocol to be amended.

4)A separate form is necessary for each person to be added to a protocol.

5)Note also that a different form, RSP 440, must be used for a change in PI.

6)SUBMISSION: Please submit one copy of the completed form to the IACUC office to determine what animal care and use training is necessary. After training is complete the IACUC office will notify the PI of the approval.

Requirements for final IACUC approval of personnel:

1)A formal relationship/status with UT (faculty, staff/employee, registered student, registered volunteer). Note, postdoctoral research associates are classified as staff /employee.

2)All relevant IACUC training tapes viewed.

3)Exposure Profile filed with the Safety and Health Department

Role on Project: Choose one of following from the drop-down list

Co-investigator

Research Associate (use for post-doc)

Technician

Graduate Research Assistant (use for Ph.D. and M.S. Students in Basic Medical Sciences)

Undergraduate Student

**Note that students doing rotations and summer research students should work with live animals only under direct supervision.

UT Status: Select one of the following: Faculty, Staff/Employee, Registered Student or Registered Volunteer from the drop-down list. (See Requirement 1 above).

Procedure: Please list each procedure on a separate line (e.g., surgery, anesthesia, fluid/tissue collection, euthanasia, etc) that the individual will be performing on live animals on this protocol.

Years of Experience: Years of experience FOR EACH PROCEDURE with theSPECIES used in this protocol must be indicated separately. If experience with the species to be used is zero, relevant experience with other species can be mentioned in the answer to Item 4

Revised: 06/28/2007