WICHITA STATE UNIVERSITY
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
ANIMAL PROTOCOL ANNUAL RENEWAL FORM
Date:
Principal Investigator:
Protocol Title:
Protocol #:
Date of Initial Approval:
Expiration Date (for this reporting period):
Animal Species:
1. RECORD OF ANIMAL USAGE:
SPECIES
TOTAL #
APPROVED FOR
PROTOCOL
TOTAL #
USED FOR
PROTOCOL
TOTAL #
USED FOR
PAST YEAR
2. NATURE OF THE PROTOCOL/STUDY:
Survival (Chronic) Study Prolonged Restraint Inducement of a Disease State
Terminal (Acute) Study Neuromuscular Blockers Inducement of Behavioral Stress
Multiple Surgeries Antibody Production Administration of Test Substances
Blood/Tissue Collection Transgenic Breeding Other:
3. (USDA) PROJECT (Pain) CATEGORY: C D E
Category C: Involves procedures that cause no pain or no more than momentary or slight pain and no
pain-relieving drugs are used.
Category D: Involves procedures that may cause more than momentary or slight pain or distress for
which appropriate sedatives, analgesics, or anesthetics will be administered.
Category E: Involves procedures that may cause more than momentary or slight pain or distress for
which sedatives, analgesics, or anesthetics cannot/will not be administered due to scientific
considerations/requirements.
4. PROTOCOL STATUS:
A. Active - project ongoing
B. Currently inactive - project was initiated but is presently inactive.
C. Inactive - project never initiated but anticipated start date is:
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5. FUNDING SOURCE: Specify the funding source. Include the grant or proposal number as applicable.
6. PROJECT PERSONNEL: Please list all personnel working on this project.
Name and Highest Degree
Role/Responsibility for Project
6a. Are you requesting to add any new personnel at this time?
No, skip to #7.
Yes, please complete the below box.
Name and Highest Degree
Years and Relevant
Experience
Role/Responsibility
for this project
6b. If new personnel do not have experience, how will they be trained? Or state N/A.
7. PROGRESS REPORT. If the status of this project is 4.A. (Active; project ongoing) or 4.B. (Project was
initiated, but is presently inactive), provide a brief update on the progress made in achieving the specific
aims of the protocol. Please include in your answer how animals were utilized during this reporting period
and how that fits with the total number of animals approved for the protocol. Please provide an explanation
for any large discrepancy between the number of animals requested and those utilized to date. If the
status of the project is 4.C. (Inactive - never initiated) you may state N/A.
Page 3 Form Revised January 2017
8. PROBLEMS/ADVERSE EVENTS. If the status of this project is 4.A. (Active; project ongoing) or 4. B.
(Project was initiated, but is presently inactive), describe any unanticipated adverse events, morbidity or
mortality, the cause(s), if known, and how these problems were resolved. If NONE, this should be
indicated. If the status of the project is 4.C. (Inactive - never initiated) you may state N/A.
9. ALTERNATIVES TO ANIMAL USE. Alternatives to the use of animals should be considered and used
when possible. Since the last IACUC approval:
A. Have alternatives to the use of animals become available that could be substituted to achieve your
specific project aims?
B. What sources were utilized to consider alternatives? Please provide at minimum:
1. The name of the database(s) searched:
2. The date the search was performed:
3. The period covered by the search:
4. The key words and/or the search strategy used:
10. ALTERNATIVES TO POTENTIALLY PAINFUL PROCEDURES. (Address the following if your project
involves USDA Category D or Category E.) Procedures that cause the least amount of pain or distress
to the animals should be considered and used when possible. If your project is a USDA Category C, you
may state N/A.
A. Since the last IACUC approval, have alternatives which are potentially less painful or distressful
become available that could be used to achieve your specific project aims?
B. Please provide at minimum:
1. The name of the database(s) searched:
2. The date the search was performed:
3. The period covered by the search:
4. The key words and/or the search strategy used:
Page 4 Form Revised January 2017
11. DUPLICATION. Activities involving animals must not unnecessarily duplicate previous experiments.
Provide written assurance that the activities of this project remain in compliance with the requirement that
there must be no unnecessary duplication and note how this was determined (e.g. database search).
12. FUTURE PLANS
No changes are planned; the project will continue as previously approved by the IACUC.
Changes are planned. (Submit an amendment describing proposed changes. Please
note that if the modifications are significant, you may be required to complete a new
application. If you have questions or require assistance in making this determination,
please contact the IACUC Chairperson and/or the Attending Veterinarian.)
Other, explain:
CERTIFICATION OF THE PRINCIPAL INVESTIGATOR. Signature certifies that the Principal Investigator
understands the requirements of the PHS Policy on Humane Care and Use of Laboratory Animals, applicable
USDA regulations and the Institution’s policies governing the use of vertebrate animals for research, testing,
teaching or demonstration purposes. Signature further certifies that the investigator will continue to conduct the
project in full compliance with the aforementioned requirements.
Signature of the Principal Investigator Date
Signature of IACUC Representative Date
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