New Permanent Procedure Request Form

Details of applying Principal Investigator:

Name of Principal investigator *

Ethics No. *

E-mail *

Cellular

Details of Requested Procedure

Name of requested procedure: *

Severity level (only for this procedure and not necessarily for the whole research)

The PI should fill-out this form as detailed as possible, in a clear manner while making sure that all the procedures in the protocol are detailed and described chronologically.

Please note:
Safety instructions do not make part of the procedure template. All safety issues should be addressed in the dedicated safety page of the ethical form.

1. Type of animal

2. Description of the trial course

3. Anesthesia (choose according to the methods indicated in the ethics system, for the type of animal)

4. Pain relief (choose according to the methods indicated in the ethics system, for the type of animal)

5. Follow up on the animals in the trial and setting up early withdrawal points

6. Way of euthanizing the animals

7. Additional/comments

Principal Investigator’s signature *

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