Fill - Free fillable IACUC Application For Agricultural Research Or Teaching PDF form

APPLICATION TO USE LIVE VERTEBRATE ANIMALS IN

Agricultural Research or Teaching

Arkansas Tech University

Institutional Animal Care and Use Committee (IACUC)

Principal Investigator (PI) NAME(s): DEPT:

____________________________________ ___________________________________

WORK PHONE: EMAIL:

____________________________________ ___________________________________

NAME OF THE LAB or ACTIVITY: NAME or NUMBER OF COURSE(S)

____________________________________ ___________________________________

SITE OF THE LAB or ACTIVITY: __________________________________________

 All five major sections of the application must be completed within the form field provided.

 If some portion of a section of this application does not apply to your project, please indicate as not

applicable (NA).

 If attachments are necessary to provide a response to a specific section, or portion thereof, the attachment

must be clearly referenced under the appropriate section and the section number noted on the attachment.

 If the investigator has a question about the completion of this form, please contact the ATU IACUC Office for

clarification via the Office of Sponsored Research and University Initiatives (880-4329 or email

IACUC@atu.edu )

OFFICE USE ONLY

Protocol Number: ______________

Approval period:

____________ _____________

From To

Approval may be up to 3 years

SECTION 1: RELEVANCE AND/OR JUSTIFICATION FOR THE LAB or ACTIVITY

1.1 Please provide a brief synopsis of the lab including the rationale to support its objectives

(e.g. intended benefits to humans, animals and/or the advancement of scientific knowledge). This

section should be understandable to a general reader. Note: More detail on the specific types

and numbers of animals will follow in section 2; types of procedures and effects on animals in section 3;

safety concerns for humans in section 4; and finally, on-campus approvals are in section 5 at the end.

1.2 Clearly articulate the specific justification for the use of live vertebrate animals to explain

why the project objectives cannot be accomplished using an alternative model (e.g. in

vitro, computational model/simulation, invertebrate animals, or other).

SECTION 2: ANIMALS TO BE UTILIZED IN THE LAB or ACTIVITY

2.1 Please list the approximate number, age, sex and name of the animals to be used.

(Example: 30 head of two year old beef heifers)

2.2 Please list the source of the animals. (Example: Replacement heifers from ATU Farm)

SECTION 3: ANIMAL PROCEDURES AND FURTHER JUSTIFICATION, IF WARRANTED

3.1 Please provide a concise description of the proposed procedures that involve the use of

animals in this project. Where appropriate, this section should clearly identify specific

procedures intended to minimize pain such as anesthetic, analgesic or tranquilizing drug

application if utilized. Note: an annual report of the actual number of animals collected by species must

be provided to the IACUC.

3.2 Check which of the following pain categories applies to the procedures to be used on

animals in this project. Note: letter designations correspond to the eventual USDA report; where A and

F are reserved to report the numbers, types, and totals of affected animals.

____ B – animals collected and bred/held as part of the project

____ C – procedures will cause no (or minimal) pain or

____ D – procedures involve pain or distress but anesthetics or tranquilizing

drugs are used

____ E* – procedures involve pain or distress and no anesthetic, analgesic or

tranquilizing drugs can be used

* If any category “E” procedures will be performed, you must complete sub-section 3.3 below and 3.4 if

applicable.

3.3 Justification for special circumstances (USDA pain category “E” procedures only).

Projects involving USDA pain category “E” procedures require specific scientific

justification of why the procedure is necessary without mitigation. Note: Certain animal

husbandry-related procedures (standard agricultural practices) may be conducted without anesthesia after

consideration and approval by the IACUC. These procedures should be performed early in the life of the

animal in accordance with accepted veterinary practices.

3.4 Euthanasia. Describe the final disposition of the animals used in the project. If

euthanasia is planned, state whether the method of euthanasia is consistent with the

recommendations of the American Veterinary Medical Association (AVMA) Guidelines

for the Euthanasia of Animals (link available at the end of this document). If not, describe

the method and provide a scientific justification for the deviation.

3.5 Additional Training: (if required)

SECTION 4: SAFETY

4.1 Past the normal rigors of working with farm animals, what human safety issues are

peculiar to this lab. Briefly describe your plans to minimize risks or reference specific

standard operating procedures for the field.

4.2 Will your work involve hazardous materials, objects, equipment or activities other than

above? If so, list associated specific training modules that will be completed by any

personnel involved in those procedures (see module list and associated training links

available through http://www.atu.edu/physci/training.php Alternatively, specify other

required safety training.

SECTION 5: APPROVALS AND ACKNOWLEDGEMENTS

5.1 Principal Investigator acknowledgement of familiarity with the IACUC process,

responsibility for appropriately training all personnel who will handle animals in this project, and

assertion that this document is submitted in good faith as part of that process (add rows as

needed for co-PI’s):

__________________ _____________________________________ ______________

Name Signature Date signed

Principal Investigator

5.2 Departmental approval (only needed if using Departmental budget):

If proposed animal use is be supported by departmental or other funding not administered by the ATU

Budget Office, then departmental approval is required before IACUC approval may be granted. If the

Department Head is also an investigator on the project, this approval must be obtained from the next

higher level of administrative authority not involved in the project.

“I have read the Application to Use Live Vertebrate Animals, and I consider the project as proposed to

be appropriate in design. Furthermore, I consider the investigator(s) to be competent to perform (or

supervise) procedures in this project. My signature below denotes departmental approval of this study

as submitted

.”

__________________ _____________________________________ ______________

Name Signature Date signed

Department Head (or alternate)

5.3 ATU IACUC approval:

_Alvin Williams, D.V.M. ______________________________________ ______________

Name Signature Date signed

Chair, ATU IACUC

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Resources:

 Sources: guidance and technical terminology in this document are largely from these sources, but any errors

or deficiencies are the responsibility of TECH’s IACUC which is overseen by the Office of Academic Affairs.

 A link to NIH Office of Laboratory Animal Welfare - Vertebrate Animals Section

http://grants.nih.gov/grants/olaw/vertebrate_animal_section.htm

 American Veterinary Medical Association (AVMA) Guidelines for the Euthanasia of Animals

https://www.avma.org/KB/Policies/Documents/euthanasia.pdf

 Example of UDSA report that will eventually go from the ATU-IACUC to the USDA to indicate format.

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Fillable IACUC Application For Agricultural Research Or Teaching

Fill Online, Printable, Fillable, Blank IACUC Application For Agricultural Research Or Teaching Form

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