Application for an Individual Authorisation under
Scientific Animal Protection Legislation
For details on completing this application form, please see the ‘Guide to Applications for
Individuals under Scientific Animal Protection Legislation’.
SECTION A: APPLICANT AND BREEDER/SUPPLIER/USER DETAILS
APPLICANT DETAILS
Title:
First name:
Surname:
Address 1:
Address 2:
Address 3:
County:
Telephone:
E-mail:
Student/Staff Number:
Current position:
Have you completed a relevant approved or accredited scientific animal training course?
Yes
No
If ‘yes’ please append a copy of the successfully completed course certificate.
If ‘no’ please comment:
Is the application for a full-term individual authorisation of 5 years or a once-off short-term
individual authorisation of two weeks or less?
Full-term
Short-term
If a short-term authorisation is requested, provide details of the HPRA-authorised project,
the activities expected to be carried out and the timeframe for which authorisation is
requested (include specific dates if possible):
If you currently hold a valid individual authorisation for a different user establishment(s),
provide each individual authorisation number below (if applicable, no additional
documentation is required at the time of submission):
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BREEDER/SUPPLIER/USER DETAILS
NAME OF BREEDER/SUPPLIER/USER FOR
WHICH INDIVIDUAL AUTHORISATION IS
SOUGHT
BREEDER/SUPPLIER/USER
AUTHORISATION NUMBER
Other than the authorised user above, list any additional unauthorised location where you
plan to conduct euthanasia (outside of a project authorisation) if relevant:
Provide a scientific justification as to why this additional unauthorised location is necessary:
SECTION B: INDIVIDUAL DETAILS AND PURPOSE OF INDIVIDUAL AUTHORISATION
Indicate the proposed purpose of individual authorisation (select all that apply):
Project management
Carrying out procedures
Performing euthanasia
Please append CV indicating your suitability for the purpose(s) selected for authorisation above.
For an application to carry out procedures involving the use of neuromuscular blocking agents,
in addition to the CV, please also append the relevant training records and provide a strong
justification as to why it is necessary to apply for the use of neuromuscular blocking agents.
Please refer to the ‘Curriculum vitae for individual applications under scientific animal protection
legislation’ and the ‘Individual authorisation application training record under scientific animal
protection legislation’ available on the HPRA website.
SECTION C: PRECISE DETAILS
Complete the questions relevant to the application only.
1
Where the purpose of the individual authorisation includes project management,
indicate the species of animal(s) for which authorisation is sought:
Species
2
Where the purpose of the individual authorisation is to carry out procedures on animals,
select the category or categories of procedure(s) and enter the species of animal(s) for
which authorisation is sought using the tables below.
USE OF NEUROMUSCULAR BLOCKING AGENTS
Note: evidence of education, training and experience must be provided through
submission of CV and training records, and a strong justification must be provided as to
why the use of neuromuscular blocking agents is required.
Species
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NON-INVASIVE BEHAVIOURAL PROCEDURES HAVING THE POTENTIAL TO CAUSE
THE ANIMAL PAIN, SUFFERING, DISTRESS OR LASTING HARM
Species
BREEDING OF GENETICALLY MODIFIED ANIMALS
Species
SURGICAL PROCEDURES INVOLVING GENERAL ANAESTHESIA AND ANALGESIA
Species
NON-RECOVERY PROCEDURES (INCLUDING SURGICAL PROCEDURES)
CONDUCTED UNDER TERMINAL GENERAL ANAESTHESIA
Species
MINOR/MINIMALLY INVASIVE PROCEDURES INVOLVING SEDATION, ANALGESIA
OR GENERAL ANAESTHESIA
Species
MINOR/MINIMALLY INVASIVE PROCEDURES NOT REQUIRING SEDATION,
ANALGESIA OR GENERAL ANAESTHESIA
Species
NUTRITIONAL MODIFICATIONS RESULTING IN DEFICIENCIES IN ANIMALS’
DIETARY NEEDS AND/OR WITHDRAWAL OF FOOD FOR A PERIOD OF 24 HOURS OR
MORE
Species
OTHER PROCEDURES, PLEASE SPECIFY
Species
3
Where the purpose of the individual authorisation is to perform euthanasia on animals,
choose the method(s) of euthanasia for which authorisation is sought and indicate the
species of animal(s) for which authorisation is sought using the table below. Select all
that apply.
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Nonhuman
primates
Large
Mammals
Dogs, Cats,
Ferrets,
Foxes
Rabbits
Rodents
Birds
Reptiles
Amphibians
Method
Fish
Animal
Anaesthetic
overdose
Captive bolt
Carbon
dioxide
Cervical
dislocation
Concussion/
percussive
blow to the
head
Decapitation
Electrical
stunning
Inert gases
(Ar, N2)
Shooting with
a free bullet
with
appropriate
rifles, guns
and
ammunition
If a method of euthanasia other than the methods approved in Annex IV of Directive
2010/63/EU is to be used, provide details on the method proposed and a justification as to why
this method is necessary:
SECTION D: DECLARATION AND UNDERTAKING
The declaration and undertaking below must be signed by the individual applicant and the
compliance officer responsible for ensuring compliance with the provisions of Directive
2010/63/EU and S.I. No. 543 of 2012 at the authorised breeder/supplier/user.
Applicant
I hereby declare that authorisation is sought for the purposes indicated above in Section B
and C and that the information provided in this application form is correct and complete.
I hereby declare that in the event of the authorisation being granted:
- I will respect the principles of replacement, reduction and refinement (i.e. the 3R
principles) and comply with the terms and conditions of the authorisation.
- I will use the authorisation only for the purposes stated above in Section B and C.
I hereby undertake, in the event of the authorisation being granted, to ensure fulfilment of the
obligations arising by virtue of the terms and conditions of the authorisation.
Signature of applicant: ______________________
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Print/type name:
Date:
Compliance officer responsible for ensuring compliance with the provisions of Directive
2010/63/EU and S.I. No. 543 of 2012 at the authorised breeder/supplier/user
I hereby declare that :
- the applicant is affiliated to the authorised breeder/supplier/user referred to in Section A.
- I understand that if the applicant fails to uphold his/her responsibilities under Directive
2010/63/EU and S.I. No. 543 of 2012, this may have implications for the continued
authorisation of the authorised breeder/supplier/user concerned.
I hereby undertake, in the event of the authorisation being granted to the applicant:
- that he/she has or shall be provided with appropriate training, education and experience
for the work outlined in this application.
- that if he/she is a first time applicant, that he/she shall be supervised in the performance
of the above tasks until he/she has demonstrated requisite competence.
- to ensure maintenance of accurate and up-to-date training records demonstrating training
received by, supervision provided to, and competence attained by the applicant.
Signature of compliance officer: ______________________
(on behalf of breeder/supplier/user)
Print/type name:
Date:
CHECKLIST
CV (setting out education, experience and training)
Training record (mandatory for the use of neuromuscular blocking agents only)
Training course certificate
Fee application form and accompanying fee
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