ࡱ> ehd{ 9bjbjzz 8PO :::::NNN8lN:~w/d4;:=:=:=:=:=:=:$=?a:E:wwa::::AAA^::;:A;:AA,|-0HO R%R5-'::0:G-t@wt@$--&t@:. Aa:a:Y:t@ : AV REPORT OF ANIMAL ILLNESS, INJURY, OR UNANTICIPATED DEATH If an animal is ill or injured, contact the Attending Veterinarian, Dr. Teresa Doscher, immediately (Work Phone: 229-333-5769; E-mail: thdosche@valdosta.edu) This report must be filed with the Institutional Animal Care & Use Committee within 72 hours of the event. Send the report to: IACUC Administrator, Office of Sponsored Programs & Research Administration or iacuc@valdosta.edu. Protocol Number: AUP-  FORMTEXT       PI/PD:  FORMTEXT       PROTOCOL TITLE:  FORMTEXT       Description of Illness, Injury, or Unanticipated DeathDate Injury/Illness/Death Noted: FORMTEXT      Time Noted: FORMTEXT        FORMCHECKBOX A.M.  FORMCHECKBOX P.M. Location of Animal(s) (Bldg/Room): FORMTEXT      Species (Common Name): FORMTEXT      Number of Animals Affected: FORMTEXT       1.Briefly describe the situation.  FORMTEXT       2.Was the suspected cause related directly to research use (e.g., drug treatment, handling and restraint, failure of environmental control systems, transport or shipping, other research related activity)  FORMCHECKBOX  Yes  FORMCHECKBOX  No Identify specific suspected research related cause:  FORMTEXT TUVWc ʸoooZH7 h-]hwCJOJQJ^JaJ#h-]hw5CJOJQJ^JaJ(h-]hH%5B*CJOJQJ^Jphh E55B*OJQJ^Jph$h-]hH%5B*OJQJ^Jph(h-]hH%5B*CJOJQJ^Jph h-]hH%CJOJQJ^JaJ#h-]h 5CJOJQJ^JaJ#h-]hH%5CJOJQJ^JaJ#h-]hH%5CJ OJQJ^JaJ"h-]hH%56OJQJ^JaJUVW T V  $<<$Ifa$gdwgdA$&d P a$gdw$d &d N P gdH%$a$gdH%gdH%     ͼnZ?n!:jh-]h$_5>*CJOJQJU^JaJmHnHu5jh-]hh5>*CJOJQJU^JaJ&h-]h$_5>*CJOJQJ^JaJ/jh-]h$_5>*CJOJQJU^JaJ#h-]h$_5CJOJQJ^JaJ#h-]hw5CJOJQJ^JaJ#h-]hH%5CJOJQJ^JaJ h-]hwCJOJQJ^JaJ h-]hwCJOJQJ^JaJ h E5hwCJOJQJ^JaJ h-]h~CJOJQJ^JaJ     , . 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FORMTEXT      3.What immediate actions were taken and when? FORMTEXT      4.What follow-up actions were taken and when? Can anything else be done to prevent or minimize recurrence of the incident? 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