**ACORP Appendix 8**

**[Request to Use Explosive Agent in the Animal Facility or in
Animals]{.smallcaps}**

**[Version 3]{.smallcaps}[ ]{.smallcaps}**

1\. Principal Investigator(s):

2\. Give the name(s), title(s), and prior pertinent training and
experience of individuals who will administer the explosive agent.[
]{#Text2}

3\. Name of the explosive agent(s), and the Material Safety Data Sheet
number(s):

4\. Why can't a non-explosive agent or agents be used instead?[
]{#Text4}

5\. Give the beginning and ending dates during which the explosive
agent(s) will be used.[ ]{#Text5}

6\. Give a brief description of the studies for which the use of an
explosive agent is proposed.[ ]{#Text6}

7\. Give the species, weight, and approximate number of animal subjects
that will be administered the explosive agent(s).[ ]{#Text7}

8\. Give the building and room number in which agent(s) will be used.[
]{#Text8}

9\. Give a detailed description of the procedure(s) involving the
explosive agent(s) including assurances that: a) procedures are
performed within a properly operating, ventilated safety hood, b) all
electrical equipment used with the agent are placed and powered outside
the hood, c) once the seal is broken on containers of ether or other
explosive anesthetic agents, they will be placed into a safety hood
throughout use, stored in an explosion proof refrigerator or other
approved storage area, and discarded properly once completely used, and
d) that proper disposal procedures for items (including carcasses)
containing traces of the agent will be safe and appropriate. (When
finished, proceed to item Y on the ACORP.)[ ]{#Text9}

10\. Required signatures.

a\. Principal Investigator(s) submitting this request.

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  Name(s) of Principal Investigator(s) (typed)   Signature(s)   Date
                                                                
                                                                
                                                                
                                                                
                                                                
                                                                
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b\. Approving officials.

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  Name of IACUC Chair (typed)                          Signature   Date
                                                                   
                                                                   
                                                                   
  Name of Attending Veterinarian (VMO or VMC, typed)   Signature   Date
                                                                   
                                                                   
                                                                   
  Facility Safety/Biosafety Officer (typed)            Signature   Date
                                                                   
                                                                   
                                                                   
  ACOS for R&D (typed)                                 Signature   Date
                                                                   
                                                                   
                                                                   
  VISN Regional Safety Officer (typed)                 Signature   Date
                                                                   
                                                                   
                                                                   
  ---------------------------------------------------- ----------- ------