Animal Contact Incident Form

Purpose: This form is provided to the effected person or supervisor for the purpose of collecting information when there is an unexpected contact incident in the animal care facility, or if in the usual contact with an animal, there is an adverse reaction.

Instructions: (1) The effected person (when available and as soon as possible) or supervisor (if the person is not available) must complete this form. For data that is not known, indicate "unknown". (2) Make a copy of the completed form. (3) Complete the "Employee's First Report of Injury" form (TSU-SORM-29). (4) Submit one copy of this form and the SORM-29 to the Office of Risk Management. (5) Submit the copy of this form to the Office of Research.