TMC動物入室揭露說明表單 TMC Animal Transfer Disclosure Form

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1. 動物健康狀態 Animal Health Status
(1) 是否為基因轉殖鼠 Genetically modified mouse?
動物在外觀、生理或行為上是否會與原品系有差異? Are there phenotypic, physiological, or behavioral differences from the original strain?
(2) 動物是否曾經進行手術? Has the animal undergone any surgery?


(3) 入室前動物標示方式? Animal identification method before transfer?
(4) 動物是否曾給予 substance (化合物、混合萃取物、生物製劑)? Has the animal been administered any substance?
a. 給予 substance 名稱 Name of substance:
b. 可能造成的症狀、作用? Possible symptoms or effects?
c. 是否曾經進行危險性物質給予? Has hazardous substance been administered?
(5) 是否曾經接種病毒載體? Has the animal been inoculated with a viral vector?
a. 請說明種類? Please specify type
b. 生物安全等級? Biosafety level
2. 動物入室後是否給予 substance? Will substances be administered after transfer?
(1) 給予 substance 名稱 Name of substance:
(2) 種類 Type:



a. 滅菌方式 Sterilization method:
b. 毒性資料 Toxicity data:
(3) 是否對操作人員造成危害? Is there a hazard to personnel?
(4) 動物是否預期產生症狀、作用? Are symptoms/effects expected?
3. 動物入室後是否給予細胞? Will cells be administered after transfer?
(1) 細胞種類 Cell type:
(2) 細胞取得來源 Cell source:
4. 動物入室後是否給予病毒載體? Will viral vectors be administered after transfer?
(1) 請說明種類? Please specify type
(2) 生物安全等級? Biosafety level
5. 特殊飼養照護 Special husbandry and care
6. 描述人道終點 / 試驗動物中止試驗標準 Humane endpoints / Criteria for study termination


TMC動物入室揭露說明表單

計畫主持人 (PI):
📩 寄件提醒：
本表單請寄送至：tmcvet5516@gmail.com
副本欄位請務必填上 PI E-mail
日期:
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