Fillable IACUC Application For Field Research Or Teaching 2

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IACUC Application For Field Research Or Teaching 2

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APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
Principal Investigator (PI) NAME(s): DEPT:
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
WORK PHONE: EMAIL:
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
NAME OF THE LAB or ACTIVITY: NAME or NUMBER OF COURSE(S)
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
TITLE OF PROJECT/ BUDGET NAME (assigned by ATU Budget Office if applicable):
TYPE OF PROJECT (please check one): ___ Research ___ Teaching/training ___
Collection/Banking
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).
APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
SECTION 1: PROJECT RELEVANCE/JUSTIFICATION (SYNOPSIS)
1.1 Please provide a brief synopsis of the project 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 and focus on the big picture.
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).
APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
SECTION 2: ANIMALS TO BE SAMPLED, HANDLED, AND/OR REMOVED FROM NATURE
2.1 Please indicate the target taxa and estimated number of animals involved in this project
(e.g. 100 small mammals, 50 channel catfish, 15 assorted Actinopterygii fishes).
2.2 If a special permit is required for the target taxa, provide a photocopy of the approved
permit or permit application. Summarize the agency(ies) involved, status, and
associated timeline of the permit (e.g. when the application was or will be submitted as well as spatial
and temporal coverage).
APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
2.3 If dogs or cats are to be used, please specify the source of the animals.
SECTION 3: ANIMAL PROCEDURES AND FURTHER JUSTIFICATION, IF WARRANTED
3.1 Please provide a summary list 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. 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.
APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
____ B – animals collected and bred/held as part of the project
____ C – procedures will cause no (or minimal) pain or distress (e.g. identification
and measurements, injections, blood sampling, tattooing, electrofishing, live-trapping,
netting, marking by fin-clip or toe-clip, health assessments,…)
____ 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 (e.g. leg-hold traps, confinement in adverse
environments, or procedures with death as an endpoint, like rotenone sampling for fish)
* 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.
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.
APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
3.5 Please indicate the site(s) where the procedures will be performed if it is not already
described on permitting documents associated with Section 2.2.
SECTION 4: SAFETY
4.1 Past the normal rigors of working in natural habitats, what human safety issues are
peculiar to the type(s) of animal collection, handling, and/or holding proposed for this
project? Briefly describe your plans to minimize risks or reference specific standard
operating procedures for the field.
APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
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
Department Head (or alternate)
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.”
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APPLICATION TO USE LIVE (WILD/FERAL)
VERTEBRATE ANIMALS in Field Research or Teaching
Arkansas Tech University
Institutional Animal Care and Use Committee (IACUC)
OFFICE USE ONLY
Protocol Number: ______________
Approval period:
____________ _____________
From To
Approval may be up to 3 years
__________________ _____________________________________ ______________
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
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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IACUC Application For Field Research Or Teaching 2

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Completed 16 March 2020

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