Duke RBL Animal Model/Study Request

Duke RBL Animal Model/Study Request

Requestor Name*

Requestor email address*

PI Name*

How would you like to run your animal study in our facility?*

Core Service Study (RBL staff runs the full study, no effort on sponsored research)
Independent Study (Requesting lab team must be approved by DHVI Safety, Duke IACUC, and DLAR for work in RBL vivarium)
Sponsored Research Study (Choose program, RBL staff has effort on grant)

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CR Request #

Please choose Sponsored Research program*

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Duke Fund Code*

Study Details

If your study involves immunizations or treatments, a document detailing concentrations and endotoxin levels must be attached to the request. Studies will not be scheduled until this information is received.

What type of animal study?

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Desired start date*

What immunogens or treatments will be used?*

Immunogen/Treatment use details*

Please provide source, dose, units, storage requirements, method of formulation/dilution, timing of boosts (if applicable)

Adjuvant*

(if applicable) Please provide name, source, dose and method of formulation with immunogen

Date Material will be available*

Please provide the date sufficient quantity of the experimental product(s) are available for this requested animal study. Please note the material must be pharmaceutical grade or documented low/no endotoxin. Upload documentation below.

Requested Route of Delivery*

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Requested immunization/treatment schedule*

Requested pathogen challenge*

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Influenza challenge strain*

Please Note: A safety review and LD50 dose study will be needed for additional strains not specifically listed below.

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SARS CoV-2 challenge strain*

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Animal Species

Animal Species*

Please enter desired species if not listed in the drop down.

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Other*

Proposed number of animals in the full study?*

Will animals be pre-treated/altered prior to arrival into the GHRB animal facility (e.g. chemical, radiation, surgery, biological)?

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Please Describe*

Animal Source

Animal Source*

GHRB-Global Health Research Building is home to the Duke RBL Regional Biocontainment Laboratory (RBL) and ABSL2/3 Vivarium

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Current DLAR building/room*

Current Duke IACUC Number*

Please tell us the the current IACUC number for the animal transfer

Animal Vendor or Source*

Jackson Lab or Charles River Preferred vendors

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Animal Strain*

Provide full strain name / genotype

Preferred Sex*

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Cage Numbers if applicable

Duke Fund Code for Animal Purchase*

Duke Fund Code for per diems*

Compliance & GHRB Vivarium Access

Duke IACUC Compliance

Please let us know which Duke IACUC Protocol you want to use for this study (we prefer you use our Duke RBL Protocol)

Use Duke RBL IACUC

Duke IACUC Number*

Please provide your approved Duke IACUC number to be used.

Is this IACUC protocol approved for animal housing in the GHRB Vivarium?*

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Do you and/or your lab members need GHRB / Duke RBL Card Access?*

GHRB Building requires iCLASS type DukeCards which are not typical

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Do you have card access to GHRB and the GHRB Vivarium?*

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Please list persons needing access*

Will the study involve treatment/infection with a hazardous ABSL-2 or ABSL-3 agent (ex: virus, microbe, radiation, chemical, toxin, rDNA, viral vector, etc.)*

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Describe the hazardous agent for the proposed study*

Duke IBC Registration (please provide your IBC# or indicate DUKE RBL Registration to be used)*

Animal Biosafety Level*

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Permits & Material Transfer Agreements

Do you need to make us aware of any applicable or restrictive permits/MTAs?*

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Please Describe*

Comments

Supporting File Upload

File Attachments

Please attach/upload to the Service Request any relevant Safety or Procedure relevant documents to assist us in developing your study plan and cost proposal. Please also make sure all documents have the Core Research Request number in their filename

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