Small Animals Facility for Experimentation (SAFE

Small Animals Facility for Experimentation (SAFE

INDIAN INSTITUTE OF SCIENCE EDUCATION & RESEARCH, MOHALI
IISER Mohali, Knowledge city, Sector 81, SAS Nagar, Manauli PO 140306
Small Animals Facility for Experimentation (SAFE)
ANIMAL REQUISITION FORM
_____________________________________________________________________________________
Date of Requisition:
Date when Required:
(Requisition must be submitted atleast 3 days prior to date which animals are required)
Experimental & Animal Details:
Name of Investigator:
IAEC approval No.:
Species & Strain:
Age/weight:
Department:
IAEC Approval Date:
Number required:
Sex:
Disposal of animals:
Do you use hazardous agents/materials: YES/NO (If YES specify handling and disposal procedure- to be
attached as annexure)
Principal Investigator
Signature of person receiving
Signature with date
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For SAFE Use:
Date Issued:____________
No. of animals approved by IAEC Number of animals in
balance
Number of animals Issued
(on date of issue)
Veterinarian/In-charge
SAFE
Balance (as on
date of issue)
Signature of person issuing
---------------Tear Here-------------------------------- Tear Here--------------------------------Tear Here--------------------------------Tear Here-------------------
Animal return slip for disposal (sacrificed/dead) or rehabilitation :
Investigator:
IAEC approval No.:
Date issued:
Species/Strain:
Weight of bag/No. of animals:
Number Issued:
Sex: Male/Female/Both
Date Returned:
Remarks if any:
Returned By:
(Signature with date)
Veterinarian/In-charge
SAFE
Verified By:
(Signature with date)