ࡱ> egd{ Abjbjzz 4P %hh&&&8^&'c  L&N&N&N&N&N&N&$ (*r&]A"cr&E&"""R8L&"L&"""p=["8&&0'"?+p?+"?+"7r"\r&r&!'?+h :   Compliance Report The IBC strongly encourages faculty, staff and students to report questionable practices/behaviors, accidents and unapproved actions. Incident Reports will be placed in the appropriate IBC Registration or Facility file and the supervisor/investigator notified. Filing a Compliance Report is also a tool that researchers can use to get help on particular issues, inform the Office of Research Integrity (ORI) of facility problems. ORI will coordinate with the appropriate other UAF departments to determine how the issue(s) raised might be best addressed and resolved. Date of Incident:  FORMTEXT       Date of Report:  FORMTEXT       Principal Investigator:  FORMTEXT       IBC Registration:  FORMTEXT       Person(s) Involved: Name:  FORMTEXT       Status:  FORMTEXT       Name:  FORMTEXT       Status:  FORMTEXT       Name:  FORMTEXT       Status:  FORMTEXT       Name:  FORMTEXT       Status:  FORMTEXT       Location of Incident (include facility name and room/pen number):  FORMTEXT       Incident Description (maximum 500 words):  FORMTEXT       Was any corrective action taken by involved persons?  FORMCHECKBOX  None  FORMCHECKBOX  Re-training Describe:  FORMTEXT       Training By:  FORMTEXT        FORMCHECKBOX  Verbal Notification Individual(s) Notified:  FORMTEXT       By whom:  FORMTEXT        FORMCHECKBOX  Written Notification Individual(s) Notified:  FORMTEXT       By whom:  FORMTEXT        FORMCHECKBOX  Activity stopped Stopped By:  FORMTEXT        FORMCHECKBOX  Other Explain:  FORMTEXT       If personal injury resulted from the incident, was an HYPERLINK "http://www.uaf.edu/safety/incidentreport-2012.1.pdf"UAF Accident/Incident Report Form filed?  FORMCHECKBOX  Yes  FORMCHE  Q R T ` q  V \ ^   6 @ T h r ɾ{rrrrrrrho(6CJaJh6CJaJh%(Q6CJaJhj6CJaJh+6CJaJh 6CJaJhq56CJ$aJ$h"56CJ$aJ$h56CJ$aJ$hjh h CJU h aJ$ h CJjhCJUjh CJUmHnHu( D F ~$&F>0vgd+$a$gdbgd     2 4 6 @ B D F ŴtŴ]NEhv5CJaJhvh\B*CJaJph,jhfhdgaB*CJUaJphhvB*CJaJph jhr[qB*CJUaJph,jAhfhdgaB*CJUaJphhfB*CJaJph jhfB*CJUaJphhchCJaJhch5CJaJhch\5CJaJhchx&CJaJh+h+6CJaJF H Z \ r t x z «ΚΒtiXLhbB*CJaJph jhbB*CJUaJphhchbCJaJhchb5CJaJhs5CJaJhb5CJaJhvCJaJ jhr[qB*CJUaJph,jhfhvB*CJUaJphhvB*CJaJph jhvB*CJUaJphhchvCJaJhv5CJaJhchv5CJaJ    " 0 2 F H J T V طwlXI2XX,jhch1%B*CJUaJphhch1%B*CJaJph&jhch1%B*CJUaJphhch1%CJaJh1%CJaJhchCJaJhch5CJaJhchD4d5CJaJhch\5CJaJhv5CJaJhvhbCJaJ+jh2<]B*CJUaJmHnHphu jhbB*CJUaJph,jhfhbB*CJUaJphV X f j l ̽̐|̽e̐̽N̐|,j'hch1%B*CJUaJph,jhch1%B*CJUaJphhch1%CJaJh1%5CJaJ+jh2<]B*CJUaJmHnHphu,jShch1%B*CJUaJphhch1%B*CJaJph&jhch1%B*CJUaJphh1%CJaJh h1%CJaJh1%B*CJaJph246@BDRVXlnpz|ůţyůţnWůţ,jehch1%B*CJUaJphhch1%CJaJ,jhch1%B*CJUaJphh1%CJaJh h1%CJaJh1%B*CJaJph+jh2<]B*CJUaJmHnHphu&jhch1%B*CJUaJph,jhch1%B*CJUaJphhch1%B*CJaJph DNvx|~տճzo^R;^^o,j9hfhvB*CJUaJphhvB*CJaJph jhvB*CJUaJphhchvCJaJhv6CJaJh;hv6CJaJhv5CJaJhchv5CJaJh1%h1%B*CJaJphhcB*CJaJph+jh2<]B*CJUaJmHnHphu&jhch1%B*CJUaJph,jhch1%B*CJUaJph "$&Ůјэ{ogXM;XMgX#j h2<]h1CJUaJhchvCJaJjhchvCJUaJhvCJaJhhv5CJaJhXy5CJaJhb5CJaJhch'H CJaJ+jh2<]B*CJUaJmHnHphu,jh#~h#~B*CJUaJphh#~B*CJaJph jh#~B*CJUaJphh'H CJaJhf5CJaJh'H h'H 5CJaJ 468BDPln̻wcT=cc,jch hvB*CJUaJphh hvB*CJaJph&jh hvB*CJUaJphhr|hvCJaJ+jh2<]B*CJUaJmHnHphu,jh= hvB*CJUaJphhvB*CJaJph jhvB*CJUaJphhvCJaJjhchvCJUaJ#jh2<]h1CJUaJhchvCJaJ*,.8:<HVZ\^rtvŹŌŀtiaYH1H,jhdgahXyB*CJUaJph jhXyB*CJUaJphhXyCJaJhHCJaJhXyhXyCJaJhcB*CJaJphhXyB*CJaJph+jh2<]B*CJUaJmHnHphu,jChdgahvB*CJUaJphhvB*CJaJph jhvB*CJUaJphhvCJaJjhchvCJUaJ#jh2<]h1CJUaJv *,.:HLNPd̽pe]eUMAhXyB*CJaJphhXyCJaJhHCJaJhcCJaJhXyhXyCJaJ,jhdgahvB*CJUaJph jhvB*CJUaJphhvCJaJ#jh2<]h1CJUaJhchvCJaJjhchvCJUaJhvB*CJaJph jhXyB*CJUaJph+jh2<]B*CJUaJmHnHphudfhrtxzغrcLrrAhXyhvCJaJ,jh hvB*CJUaJphh hvB*CJaJph&jh hvB*CJUaJphhXyCJaJ#jah2<]h1CJUaJhchvCJaJjhchvCJUaJhvCJaJ+jh2<]B*CJUaJmHnHphu jhXyB*CJUaJph,jhdgahXyB*CJUaJphvtv6d666; ;;h<(===<>>>>>>>>>?6666666666666666˳85Cc45C5C;5C##2<]h1CJUaJh6CJaJ#j"h2<]h1CJUaJ#j"h2<]h1CJUaJUhvCJaJh;CJaJ#j"h2<]h1CJUaJhch;CJaJjhch;CJUaJ"CKBOX  No  FORMCHECKBOX  Not Applicable  FORMCHECKBOX  Unknown Who is reporting this incident? All UAF employees are fully protected against reprisal due to good faith reporting as required by the Alaska Whistleblower Act (AS 39.90.100-150) and Animal Welfare Act, 42 CFR Part 94 (Protection of Research Misconduct Whistleblowers). Students are protected from reprisals arising from good faith reporting under Board of Regents Policy P09.01.09. The information requested in this section is strictly optional; please provide only the information with which you are comfortable. You may choose to submit this report anonymously.  FORMCHECKBOX  Primary Person Involved (self-reported)  FORMCHECKBOX  Supervisor or Principal Investigator  FORMCHECKBOX  Coworker  FORMCHECKBOX  ORI Staff  FORMCHECKBOX  Vet Services or Animal Facility Staff  FORMCHECKBOX  Other Facility User  FORMCHECKBOX  Other (explain):  FORMTEXT       Name (optional):  FORMTEXT       Phone (optional):  FORMTEXT       FOR OFFICE OF RESEARCH INTEGRITY USE ONLY: Follow-Up Activities:  FORMTEXT       Final Resolution:  FORMTEXT           Send the completed form to the Office of Research Integrity Email:  HYPERLINK "mailto:uaf-ori@alaska.edu" uaf-ori@alaska.edu Fax: (907) 474-5444 Mail: Suite 212 WRRB, P.O. 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