ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAH
1
Checklist for Investigator Managed Food or Water Restriction, Special Diet or Treated Water
2
Month/Year
Building/Room #
3
Investigator
Start date
4
Contact person
End date
5
Phone (weekday)
Protocol #
6
Phone (weekend/holiday)
7
8
Investigator will (check all that apply):
Provide Special FeedProvide Treated WaterChange CagesProvide Restricted FeedProvide Restricted Water
9
10
Mice/rats: check and document food/water at least 2x/week, Check and Document Daily if Restricted; change bottles at least weeklyAll other species: check and document food/water daily
11
12
13
Special diet?
Yes
No
Treated water?
Yes
No
14
Name of diet:
Name of treatment:
15
16
Write initials in boxes corresponding to date performed.Write "NC" (No Cages) for dates when special diet or treated water were not provided.
17
Date12345678910111213141516171819202122232425262728293031
18
Animals fed
19
Animals watered
20
Cages changed
21
Place a yellow "restrictions" card on investigator maintained cages
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100