Principal Investigator:
Protocol # (if available):
Date:
SECTION M: EXEMPTIONS
FROM ANIMAL WELFARE STANDARDS*
* This section should be used to request exemptions from UMD Policies or the Guide for the Care and
Use of Laboratory Animals (2011) for scientific reasons. All exemptions are reviewed annually and
additional information may be required to sustain an exemption over the life of a protocol.
M1. EXEMPTIONS (indicate response with “X” in applicable box(es)):
Housing Density Exemption
[Complete M2]
Cage Change/ Water Change Frequency Exemption
Radios/Sound/Noise Exemption
[Complete M3]
[Complete M4]
Exemption from Enrichment
[Complete M5]
Exemption from Social Housing
[Complete M6]
Environmental Conditions/Housing and Husbandry Exemption
Restricted food/fluid
Prolonged restraint
[Complete M7]
[Complete M8]
[Complete M9]
Non-pharmacological grade compounds
[Complete M10]
Other (describe below):
[Complete M11]
M2. HOUSING DENSITY EXEMPTION
Identify group, number of animals & maximum housing density requiring this exemption
Group
# Animals/group
Max Housing Density
Describe the management plan that will be used to avoid exceeding max density indicated above.
Include any plan to return animals to standard housing density when specific conditions are met:
Justification for housing these animals at a density that exceeds established guidelines:
1
M3. CAGE CHANGE / WATER CHANGE FREQUENCY EXEMPTION
Specify maximum time that will elapse between changing
the bedding or water or animal housing:
Identify group & number of animals for each animal or study group requiring this exemption
Group
# Animals/group
Justification for extending the schedule of cleaning beyond established guidelines:
M4. RADIO / SOUND / NOISE EXEMPTION
Specify the type of sound to which animals will be exposed (e.g. radio, controlled sounds, random
noise) and describe its nature (e.g soft music, natural calls, buzzer):
Describe sound stimulus:
Volume/Decibel
Duration of exposure
Frequency of Exposure
Identify group & number of animals for each animal or study group requiring this exemption:
Group
# Animals/group
Justification for exposing animals to generated sounds or noise. If the sound is a component of the
experimental design or the plan for environmental enrichment, please describe its purpose.
M5. ENVIRONMENTAL ENRICHMENT EXEMPTION (includes food items)
Describe the specific environmental enrichment for which you request an exemption:
For each animal or study group requiring this exemption, identify the specific group and indicate the
number of animals involved:
Group
# Animals/group
Please describe the experimental or other scientific reason why animals should be exempted from
standard species-specific environmental enrichment:
2
M6. SOCIAL HOUSING EXEMPTION
Note: Animals that are not considered social do not require an exemption to be singly housed (e.g.,
animals that will fight if housed with conspecifics/conspecifics of same sex).
Describe the housing arrangement that is requested under this exemption (e.g. single housing,
restrictive housing, isolated housing):
For each animal or study group requiring this exemption, identify the specific group and indicate the
number of animals involved:
Group
# Animals/group
Please describe the experimental or other scientific reason why animals should be exempted from
standard species-specific housing conditions:
M7. ENVIRONMENTAL CONDITIONS/HOUSING AND HUSBANDRY EXEMPTION
Describe the environmental conditions for which you are requesting an exemption:
Identify group & number of animals for each animal or study group requiring this exemption:
Group
# Animals/group
Please describe the experimental or other scientific reason why animals should be exempted from
standard species-specific environmental conditions:
M8. RESTRICTED FOOD/FLUID
Please provide justification for restriction:
Duration of restriction
Frequency of restriction
Describe procedures for monitoring criteria for removing from study:
3
M9. PROLONGED RESTRAINT
Please provide justification for restraint (e.g. animal acclimatization; training; observation; behavioral
study):
M10. NON-PHARMACOLOGICAL GRADE COMPOUNDS EXEMPTION
Identify the compounds for which you are requesting under the “Non-pharmaceutical grade
compounds” category:
For each compound, explain why pharmaceutical grade equivalents will not be used:
M11. OTHER EXEMPTION
Describe the exemption that you are requesting under the “Other” category:
Identify group & number of animals for each animal or study group requiring this exemption:
Group
# Animals/group
Please describe the experimental or other scientific reason why animals should have this exemption:
4