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FORM 3.  POST-REVIEW DOCUMENTATION

October 2004 Version

A.DOCUMENTATION of REVIEW TEAM (minimum of three members for program review, and three members for facility review; add more rows as needed):

Typed Name

Role on IACUC (chair, veterinarian, scientist, lay member, non-affiliated member)

Indicate Participation in:

Program review

Facility Review

B.Documentation of Minority Opinion(s).  Any member who wishes to provide a minority opinion MUST be allowed to do so.  Did any member wish to submit a minority opinion?     

_______  Yes_________ No     If "yes", fill out section E below.

C.  DOCUMENTATION of REVIEW and APPROVAL by IACUC MEMBERS. A majority of all voting members (not a majority of a quorum) must approve and sign the report.  The report must be completed within one month of the self-assessment to facilitate IACUC review of the report.  

By our signatures, we verify that 1) we have reviewed and approved Forms 1 (Checklist) and 2 (Table of Deficiencies), 2) we have read any minority opinions appearing in item D of this report, and 3) we hereby authorize IACUC representatives to review this report with the Medical Center Director:

TYPED NAME

ROLE on IACUC (chair, veterinarian, scientist, lay member, non-affiliated member)

signature

date

Form 4 (Template for Minutes), Page 13

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