Occupational Health form

NAU Institutional Animal Care and Use Committee Occupational Health Program

Overview and purpose

The purpose of the Northern Arizona University (NAU) Institutional Animal Care and Use Committee (IACUC) Occupational Health Program (OHP) for personnel involved in animal care and use is to provide a mechanism whereby NAU can fulfill and manage its institutional responsibility to provide a safe workplace for NAU employees and students involved in the care and use of animals used for research and teaching.

Responsibilities

It is the responsibility of the principal investigator (PI), manager, or supervisor to ensure that all personnel under their supervision are enrolled in the program, are trained, and are following safe practices and procedures in the animal laboratories, workspaces, and in the field.

Participants are responsible for ensuring their own understanding of job responsibilities, safety procedures, research procedures, healthcare, and risks involved with animal care and use.

Participation

The NAU IACUC OHP requires that faculty, staff, lab technicians, students, volunteers and visitors working with animals under the auspices of NAU complete the initial NAU online enrollment form and then the NAU IACUC Occupational Health Risk Assessment Questionnaire for evaluation by the East Flagstaff Family Medical (EFFM)/Flagstaff Industrial Medicine (FIM) group. All participants are expected to have appropriate training prior to having direct contact or exposure to laboratory animals.

Instructions

Please fill out the following online form to enroll in the NAU IACUC Occupational Health Program (OHP). All components of this form must be completed prior to submission.

This form will be received by the IACUC Coordinator and the IACUC Occupational Health Program coordinator. Your application for enrollment will be verified and recorded.

Once your application has been verified, you will receive the NAU IACUC Occupational Health Risk Assessment Questionnaire form by email. Please complete ALL sections of this form and submit to the East Family Flagstaff Medical (EFFM) / Flagstaff Industrial Medicine (FIM) group by email.

Detailed instructions will be provided when you receive the NAU IACUC Occupational Health Risk Assessment Questionnaire.

EFFM/FIM will notify the Supervisor and the NAU IACUC and Occupational Health Coordinators when all components of the occupational health enrollment process have been completed.

Applicant name(Required)

Application date(Required)

Status(Required)

If other, list your home institution and affiliation with NAU

Applicant email(Required)

Principal investigator/employer(Required)

Project title/protocol #(Required)

Applicants role in protocol(Required)

List all potential species that may be worked with

Confirmation(Required)

I have reviewed the Occupational Health Enrollment form. I understand that my animal contact may be considered a health risk and that I am required to participate in the NAU IACUC Occupational Health Program.