> (Institute/Center)      Training and Experience Form

**[SECTION A: General Information]{.underline}**

**Principal Investigator (PI) or Animal User (AU) Name:**     

**ASP#/Title:**     

**Phone No.:**      **Bldg/Rm:**      **Email:**     

**PI Course completion dates: (Initial)**      **(Refresher)**     

**AU Course completion dates: (Initial)**      (**Refresher)**     

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**1)** What is your experience or training for procedures you will be
performing on this ASP (e.g. number of years working with the species
and proficiency with techniques listed such as injections, blood
collection, surgery, behavior tests, etc.)?

     

**2) [\[Name(s) of PI and/or designee\]]{.underline}**      will provide
supervision and training in the techniques I will be performing on this
ASP until I am fully qualified to perform these animal activities
independently.

**3) Yes/No:** This ASP involves Nonhuman Primates procedures. **If yes
complete Section B. If no, go to Section C.**

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**[SECTION B: Nonhuman Primate (NHP) Procedures]{.underline}**

**1)** Nonhuman Primate Safety Course: (IC component date)     

(Facility component. date(s):     ;       ;     

**2) Yes/No** There will be "awake" NHP procedures performed as a part
of this protocol, e.g. squeezing up for injections, pole/collar,
restraint chairs, operant procedures, etc. **If Yes -- complete 3 and 4.
If no, go to Section C.**

**3)** I will be performing the following awake NHP procedures:     

**4a)**\_\_\_\_\_ I am currently proficient in performing all of the
awake NHP procedures that I've listed above,

> **OR**

**4b)**     [\[name(s) of PI or designee\]]{.underline} will provide my
supervision and training until I am fully qualified to perform these
awake NHP procedures proficiently and independently.

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**[SECTION C: Assurances]{.underline}**

**Yes / No:** I have read or will read the final, approved version of
this ASP and will limit my activities to performance of only those
procedures described in the approved ASP.

**Yes / No:** I understand my responsibilities for acquiring training on
techniques I am asked to perform on animals as described in this ASP,
but am not currently proficient in performing. Additionally, if my
support role for this ASP changes, I will submit a new T&E form and
acquire training prior to performing any new procedures.

**Animal User
signature:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**Date**:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# As the PI, I assume the responsibility to ensure that this Animal User's training and experience for procedures he/she will be performing under this ASP has been or will be assessed, and if this person is not proficient in performing these procedures, training will be provided, and proficiency verified, before the person is allowed to conduct these procedures independently. 

# **Principal Investigator signature:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Date**:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_