Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General Information

  • Name:

  • Status:

  • Supervising Principle Investigator:

  • Protocol Number:

  • Species Involved:

Training

  • I have completed online training through CITI, to include all modules that relate to my research project (minimally, the "Working with XXX in Research Settings" module is required) and have submitted my certificate of completion to Dr. Malcolm Hill.

  • I have completed Lab Safety 101 training with John Conover from the SSRM Office and have submitted my completion certificate to Dr. Malcolm Hill.

  • I have completed Lab Safety 102 training with my Supervising Principle Investigator and have submitted my completed training packet to the laboratory manager in my department.

  • I have completed the hands on training required for my involvement in this IACUC approved experiment.

Health and Medical Surveillance

  • My immunization record, to include a tetanus booster, is up to date and on file in the University's Student Health Office.

  • I have received and reviewed the following waivers:

  • I understand the risks attached to conducting research projects involving live animals. I understand that I can ask for help or clarification at any time during my animal research experience.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.