This Packet Describes the Occupational Health Program For the

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This Packet Describes the Occupational Health Program For the ...

     This Packet Describes the Occupational Health Program

    For the University of Notre Dame’s

    Institutional Animal Care and Use Committee and

    Freimann Life Science Center

    For Category A

     You must complete the Category A Medical &

     Occupational History Form and return it

     to the Freimann Life Science Center office

     room 400 or Mail the completed Form to:

     Wipperman Occupational Health Clinic

     For Category B

     You must complete the Category B Certification

     Form and return it to the Freimann Life Science

     Center office room 400

VAS 7/05

     Occupational Health Program For the University of Notre Dame’s

    Institutional Animal Care and Use Committee and

    Freimann Life Science Center


     - Program Description

     -Injury Procedures

     -FLSC Safety and Hygiene Policies

     -Medical and Occupational History Form

     -Waiver Form

     -Animal Allergies Summary

     -Zoonotic Diseases Summary

     -Miscellaneous Hazards Summary

     -Blood-Borne Pathogens Guidelines

    Occupational Health Program

    For the University of Notre Dame’s

    Institutional Animal Care and Use Committee and

    Freimann Life Science Center


     A number of hazards are associated with the use of animals and animal tissues/fluids in

    research. To minimize risk associated with these hazards, the University of Notre Dame requires

    that every individual with such exposure be included in the occupational health program

    described in this document. This program is required for all employees or volunteers having

    contact with animals used in research, teaching, or testing, including temporary and part-time

    employees and students listed on animal protocols. It is not required for students participating in

    classroom use of animals in a learning exercise.


     The Occupational Health Program has the following components:

     1. Educational - The information contained in this packet is the basic informational unit of the program. Additional material and instruction may be required for those exposed to special

    hazards, such as toxic chemicals or pathogenic microorganisms.

     2. Health History - Every individual may complete and submit the enclosed Category A-Medical and Occupational History Form now or at any time. This form will be reviewed by an

    occupational health physician who will determine if additional procedures, such as a physical

    examination or precautions, will help protect you from hazards. All individuals falling into

    Category A must complete the Medical and Occupational History Form and return it to

    Freimann Life Science Center room 400 or mail it to:

     Wipperman Occupational Health

     19567 Cleveland Road

     South Bend, IN 46637

    Individuals in Category B must complete either the Category B Certification Form or fill out the

    Category A - Medical and Occupational History Form.

     3. Annual Surveillance Form - Each individual submitting the Medical and

    Occupational History Form will be required to submit an updated form annually to determine if

    significant changes in potential risk have occurred. Once completed, this form should be returned

    to Freimann Life Science Center room 400 or sent to Wipperman Occupational Health at the

    above address.

     If any questions arise regarding this program, you may contact the following FLSC

    personnel: Director (Dr. Mark Suckow) or Associate Director (Kay Stewart) at 1-6085 or

    Technical Services and Training Coordinator (Valerie Schroeder) at 1-6087.

VAS 7/05

    Occupational Health Program

    For the University of Notre Dame’s

    Institutional Animal Care and Use Committee and

    Freimann Life Science Center

1. Everyone listed on a protocol or requiring access to the animal facility will receive a packet

    that includes basic written information on key occupational health issues, including universal

    precautions, animal allergies, procedures to follow in event of an injury, etc.

2. The packet will include a description of the occupational health program. The program

    includes a Category A Medical & Occupational History Form and a Category B Certification


    A. Individuals in Category A must annually submit a completed confidential Medical &

    Occupational History Form to Wipperman Occupational Health Clinic to be reviewed by

    an occupational health physician. Individuals in this Category are those working with live

    or dead whole animals (except those working exclusively with aquatic species) or

    biohazardous agents in conjunction with animals. The reviewing physician will determine

    if any additional testing, exams, precautions or limitations need to be undertaken. The

    physician will send a summary to the Occupational Health Coordinator of FLSC for

    further action.

    B. Individuals in Category B must submit either a Category B Certification Form OR a

    completed confidential Medical & Occupational History Form. Forms submitted to

    Wipperman Occupational Health Clinic will be reviewed by an occupational health

    physician. Individuals in this Category are those working only with aquatic species, with

    freshly harvested tissues or fluids from non-biohazardous animals or requiring non-

    animal contact access to the animal facility. Any individual, who chooses to submit the

    Medical & Occupational History Form, will be required to submit an annual update. The

    Category B Certification Form indicates that individuals may reverse their decision and

    decide at any time to submit an annual Medical & Occupational History Form, simply by

    contacting the FLSC office.

3. Individuals exposed to exceptional hazards (e.g., contact with nonhuman primates, infectious

    experimental pathogens, etc.) will be required to undergo additional training as determined by

    the IACUC. Participation by individuals in such training will be documented. These individuals

    may be required to undergo testing (e.g. TB, rabies titer, etc.) or vaccination against diseases

    such as measles, Hepatitis A or B, rabies, etc. as a condition of animal protocol approval either

    for their safety or the health and well-being of the animals.

4. Periodic opportunities for additional training and education on issues related to occupational

    health for individuals having contact with animals or animal tissues/fluids will be provided. Such

    opportunities may include an annual presentation by an occupational health professional and

    continuing education bulletins circulated to all included personnel. Records of material sent and

    presentations offered will be maintained at the FLSC.

7/05, 1/08 VAS

    What To Do If You Are Injured in RCH

1. Notify your supervisor and the Animal Facility Manager of the RCH


2. Minor injuries can be treated at the University Health Services Outpatient

     Clinic (1-7497).

3. Significant injuries or health-related issues can be treated at the St. Joseph

     Medical Center Emergency Room, 801 East LaSalle Avenue, South Bend


4. If you are inadvertently exposed to hazardous chemicals, biological agents,

     or radioisotopes, call the Risk Management and Safety Office (1-5037) for


    First Aid Kits are located in RCH in rooms 013, 015.

Eyewash Stations are located in RCH in rooms: 021, 023, 025, 028, 031, 032, 029, 027.

Material Safety and Data Sheets can be found at the MSDS - Right to Know Station on the

    wall in the corridor outside room 013 (Animal Facility Office).

     8-14-06 VAS

    RCH Regulations, Policies and Procedures Including Those for Investigator Safety

    and Hygiene


     Many hazards exist within a research facility. These include zoonotic disease, risk of

    thermal injury, chemical exposure, radioisotope exposure and ergonomic injury. The regulations, policies and procedures described in this document serve to decrease these risks to people and animals and create a safe work environment.

Regulations, Policies and Procedures

    1. All users of the facility MUST schedule a training session with Valerie Schroeder prior to

     using the facility.

    2. Absolutely no visitors are allowed in the facility without special permission from the

     RCH Facility Manager or FLSC Director. This includes wives, husbands, children,

     students, and visiting scholars. Scheduled tours are provided by RCH/FLSC staff

     members, upon request. Investigators may request an orientation tour for lab personnel.

     This tour will demonstrate the proper traffic flow and can be repeated at the user’s


    3. No smoking is allowed anywhere in the building or on the grounds. Eating, chewing

     gum or applying cosmetics is only allowed in designated areas (break room, locker room,

     offices). Drinking is not permitted in any animal rooms.

    4. Enter only those animal rooms that are assigned to you - NO OTHERS. Rooms are to be

     kept locked when not in use. Do not enter a “Biohazard” area unless you have been

     properly trained to handle such animals and have been instructed to do so.

    5. Under no circumstances should animals from one room be taken into another animal

     room without specific permission from the Management. This will be strictly enforced! 6. All carts from research laboratories are to be left in the corridors and will not be wheeled

     into the animal rooms unless permission is obtained otherwise from the Management. 7. No vertebrate is to be disposed of in the trash receptacle. There is a freezer in the RCH

     hallway outside room 025 (clean side cagewashing) for animal carcasses.

    8. The following areas and equipment are OFF LIMITS TO ALL NON-RCH/FLSC


     RCH break-room and locker-room Autoclave

     Mechanical and Storage Area RCH feed cooler

     Rack and cage washers

     Temperature and lighting settings (alterations made by RCH/FLSC staff).

    9. The RCH/FLSC staff must be informed of any and all animal deaths on the Notification

     of Animal Death Forms provided in each animal room. The completed forms should be

     clipped on the outside of the animal room door for subsequent pick-up by the staff. 10. A Procedure Request Form must be filled out and left in room 013 before any animal

     procedure is scheduled. Forms are available in the RCH office. All procedures which

     require the veterinarian and/or the veterinary technicians must be scheduled in advance,

     preferably at least 24 hours in advance.

    11. Sandals and bare feet are prohibited in the animal facility. Shoe covers are required

     in designated areas. Shoe covers are not a replacement for closed toe shoes! Shoe covers

     must be removed and discarded in the appropriate receptacle when leaving the area. A

     clean smock or lab coat should be worn when working with animals. Smocks are

     provided outside of rooms or areas where they are mandatory. Some rooms will have

     smocks for the convenience of staff and researchers.

    12. Do not take any animal and/or dirty cages into the clean cage prep area. Return all soiled

     cages to the dirty side of cage wash (room 023). Do not cut through the cage washing

     area. Do not go from the dirty side of cage washing into the clean side. Clean cages may

     be obtained from the bedding room 026 across from procedure room 027 or by requesting

     them from RCH personnel. Animals, dirty cage and/or equipment are not to be

     transported through the locker room.

    13. No animals or cages are allowed in any of the offices.

    14. Do not attempt any procedure or handle any species with which you are unfamiliar.

     Always seek proper assistance and training.

    15. Absolutely no arthropods are to be brought into the facility without special permission

     from the Facility Manager.

    16. No noxious or hazardous chemicals are to be stored by non-RCH/FLSC personnel in the

     animal rooms or hoods. Anesthetics are available from the RCH staff.

    17. No radioactive material is allowed into the RCH without prior permission from the

     IACUC and the Departmental Radiation Safety Officer.

    18. No animals are to be left unattended in the corridors of Raclin-Carmichael Hall or Keck

     Center for Transgene Reaseach. No research or teaching animals are to leave the Indiana

     University School of Medicine/ RCH grounds without permission from the


    19. Anesthetized animals are not to be left unattended when there is a possibility of

     cannibalization or escape. An escaped animal is considered vermin and can be returned to

     the RCH, only to be euthanized by an RCH/FLSC staff member.

    20. All animal orders must be approved by the Management. All orders are placed by FLSC.

     There must be an approved, current protocol on file in FLSC for all animals to be

     ordered. No animals will be ordered without a current approved IACUC protocol. An

     Animal Request Form, signed by the P.I. is required.

    21. Only animals from approved sources will be allowed into the facility unless permission is

     obtained from the veterinarian prior to ordering.

    22. Animal space assignments will be made and may be changed at the discretion of the

     Management, as required, to best accommodate all investigators and to maintain animal


    23. Questions or complaints should be directed to the FLSC Director or Associate Director. 24. General clean-up, including sinks, counter tops and fume hoods, is the responsibility of

     those using the room.

    25. Wash hands before and after handling any animals to aid in animal disease control.

     Gloves must be worn when handling animals. Gloves are provided in all rooms. Avoid

     touching your face, eyes, mouth and hair following animal contacts and prior to hand


    26. The exit door between 032 and 033 of the RCH animal facility is an emergency exit only.

     Alarms will sound if this door is used.

    27. NIH Guidelines restrict the number of animals allowed in each size cage. Do not exceed

     these numbers. If you are not sure of the maximum number allowed per cage, ask.

     Always make sure that the number of animals in the cage matches the number on the

     cage card.

    28. Do not leave the access ID cards, room entry codes or animal room keys accessible to

     unauthorized personnel.

    29. Please remember that we must accommodate the needs of all investigators as best we can.

     Requests for animal rooms, animals, and tech time are to be made to Kay Stewart or

     Vicki Western.

     8-14-06 VAS

    Category A - Medical and Occupational History

    University of Notre Dame - Freimann Life Science Center


    Name___________________________________________ DOB_________________________



    Job Title ________________________________________ Today’s Date___________________

    ? Professor/Faculty ? Post-Doc ? Graduate Student ? Undergraduate Student

    ? Technician/Staff ? Co-op Student ? Summer Employee ? Visiting Faculty ? Other_______


    I will be working with OR around animals Yes_____ No_____

    I am involved with veterinary care or animal husbandry Yes_____ No_____

    I will perform surgical manipulations of animals Yes_____ No_____

    I will be working in Bio-Safety Level 3 containment Yes_____ No_____

    Check all that apply Frequency of Exposure Animal Species Daily 1-4 times/wk. 1-3 times/mo. < 1 time/mo. Mice Mice, Rodents (wild) Rats Rabbits Guinea Pigs Amphibians, Reptiles Fish Chickens, Poultry (domestic) Birds (wild-caught) Non-Human Primates Wild Mammals (carnivores) Wild Mammals (other than rodents) Tissue Type List Species Fresh Tissues/Fluids (non-biohazardous) Fresh Tissues/Fluids (biohazardous) Fixed Tissues/Fluids (non-biohazardous) Fixed Tissues/Fluids (biohazardous) Human Specimens

    Please use the back or additional sheets if needed when listing or explaining the exposure

    Exposures in the Lab Environment Yes No List/Explain


    Infectious agents/ r-DNA technologies

    Other biological agents (adjuvants,


    Chemical carcinogens


    Known reproductive hazards/


    Hazardous chemical exposures

    Part B: PERSONAL HEALTH HISTORY Have you ever had the following diseases?

    Tetanus: No____ Yes____ If yes, explain________________________________________

    Hepatitis B: No____ Yes____ If yes, explain________________________________________

    Naturally-acquired measles (rubeola)? No____ Yes____

    Have you ever had the following immunizations?

    Tetanus: No_____ Yes_____ Date__________

    Hepatitis B series: No_____ Yes_____ Date__________

    If yes, were you tested for antibody to Hepatitis B? No_____ Yes_____ Date__________

    Rabies series: No_____ Yes_____ Date __________

    If yes, were you tested for antibody to Rabies? No_____ Yes_____ Titer_____________ Date__________ Measles/Mumps/Rubella: No_____ Yes_____ Dates ________________________________

    Tuberculosis Surveillance

    Have you ever lived outside the United States? No_____ Yes_____

    If yes, list countries______________________________________________________________

    Have you received the tuberculosis vaccine Bacillus Calmette-Guerin (BCG) vaccination? No____ Yes____ If yes, have you had a Tb skin test after vaccination? No_____ Yes_____

    If yes, list month/year and results of Tb skin test: positive_____ negative_____ Date _________ Have you ever had active tuberculosis? No_____ Yes_____

    If yes, list date and describe treatment _______________________________________________

    If no, list month/year and results of Tb skin test: positive_____ negative_____ Date __________ Do you have sensitivity or reaction to the Tb purified protein derivative used in the skin test? No____ Yes____ Have you had radiographs taken related to Tb screening? No____ Yes____

    If yes, list the reason radiograph was taken:_____________________________________


    Do you have asthma? No_____ Yes_____

    What are the causes of your asthma? _______________________________________________________ Are you allergic to any animal? No_____ Yes _____

    If yes, list animals: ______________________________________________________________________ Do you have allergy symptoms/asthma related to animals that you currently work with? No____ Yes ____ If yes, list animals: ____________________________________________________________

    Do you have any other known allergies? No_____ Yes_____

    If yes, please list: _______________________________________________________________

    List the symptoms that occur related to these allergies: _________________________________ List treatments that you receive for allergy/asthma: ____________________________________ Do you have skin problems related to work? (reactions to gloves, dry/cracked skin, rashes) No____ Yes ____ If yes, describe: _________________________________________________

    Do you have a condition, or take medications, which could suppress your immune system? No____ Yes ____ If yes, explain__________________________________________________

    Do you have any ongoing medical conditions? No____ Yes ____

    If yes, explain: _______________________________________________________________

    Do you have any health or workplace concerns not covered by this questionnaire that you feel may affect your occupational health, and would like to confidentially discuss with the Occupational Health Consultant or your Personal care physician? ________________________________________

    For Women Only

    Are you currently pregnant? No____ Yes____

    Are you planning on becoming pregnant in the next year? No____ Yes____

    I have answered the questions on this form truthfully and to the best of my ability and recollection. Name (Print):___________________________________________

    Signature: _____________________________________________ Date: _________________

    Return this medical history to: OR Place in a sealed envelope

    Wipperman Occupational Health Label the envelope- Confidential Medical History

    19567 Cleveland Road Return to the FLSC office room 400

    South Bend, IN 46637 VAS 3/01Rev. 9-03 Rev. 7-05, Rev. 11-05, 1-08

    Category B Certification Form

    PI/Laboratory work phone number e-mail address

Indicate status:

    ? Faculty ? Graduate Student ? Undergraduate Student ? Post-Doc ? Technician/Staff ? Co-op Student ? Summer Employee ? Visiting Faculty

I certify that I will ONLY have contact with aquatic species, fresh tissues/body fluids/ from non-

    biohazardous animals or enter the animal facility for observation ONLY of animal procedures.

I certify that I am required to have access to the animal facility as part of maintenance,

    construction or repair functions and will not handle animals.

I understand that by declaring that I will have limited animal exposure, my access to the animal

    facility may be restricted.

I also agree to notify the IACUC and the Occupational Health Program Coordinator if my

    anticipated exposure category level should change.

I understand that I may submit an annual Medical & Occupational History Form (to comply with

    Category A requirements) at any time.

     Printed Name____________________________________________ Date_________________



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