UAF Animal Research Personnel Information Form
All personnel working with live vertebrates on UAF projects or in UAF facilities must complete this form. This information is used to determine any Occupational Health and Safety requirements for researchers in the UAF animal care program.
First Name
Your answer
Last Name
Your answer
Birthdate
Your answer
UA Identification Number
Your answer
Email Address
Your answer
Phone number
Your answer
Who is the UAF Principal Investigator on the project?
This is usually a UAF tenured or tenure track faculty member.
Your answer
What is your role or affiliation with UAF?
Check all that apply
Required
What animal species will you be handling?
If you will be working with many or unknown species, list those you reasonably expect to handle.
Your answer
Type of animals
What will be your job duties?
Your answer
Will you need access to controlled substances?
If yes, you will be contacted to provide additional information needed for access to controlled substances under the relevant DEA license.
Approximately how many contact hours per week will you spend handling live vertebrates for this project?
Your answer
Approximately how long will your participation in this project last?
Summarize your animal handling experience
Summarize your experience; the species involved, types of research or projects and approximate duration. Please don't include your whole resume.
Your answer
Special training received or Certifications earned
List any that are relevant to your current activities such as Master Banding permit holder, completed Chemical Immobilization course, or training in surgical techniques.
Your answer
Will you need access to any animal facilities to perform your work?
Check all that apply
Will you come into contact with any of the following in either the field or the lab?
Will you be using any equipment or machinery, such as motorized vehicles (ATVs, snowmachines, tractors) or power tools (hydraulic chutes, chain or band saws, firearms, etc)?
If yes to any of the above, please describe.
Your answer
Do you have any medical conditions that would increase your risk of health and safety or other conditions which may require special accommodations, additional precautions? DO NOT LIST THEM ANYWHERE ON THIS FORM- SELECT ONLY "YES" or "NO"
Such conditions do NOT preclude you from working with live vertebrates, but may require special precautions, such as animal allergies, asthma, pregnancy, immunosuppressive therapies, etc.
Please provide your own assessment of the potential hazards you will encounter during your activities involving live vertebrates, especially those that are characteristic of the particular species with which you'll be working.
(i.e. rutting muskox bulls, rabid foxes, etc.)
Your answer
Have you ever completed any UAF Occupational Health and Safety Trainings?
Check all that apply. You can look up the status of your UAF training at http://www.uaf.edu/safety/training/.
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