UWSP ANIMAL CARE AND USE PROTOCOL
Please submit the following:

Mail one printed copy with signatures to Sharon Courtney, Grant
Support Office, Old Main, 715-346-3799
Administrative summary information
IACUC use only
Protocol # ______________
Review Date ____________
P.I. name(s)
Action _________________
First renewal __________
Project title
Second renewal __________
Date (today)
Next full review __________
Project dates
Animal study summary information (expanded responses will follow on subsequent pages)
species (n)
source?
please list each species and include the number of individuals for each in parentheses
indicate if the source of the animals will be ordered from off campus, from a captive colony, or wild
population
lab or field?
indicate if the study of animals will occur in classrooms, labs, animal care facility or other UWSP
housing location, or if the use of animals will occur in the field (free-living conditions)
research or
teaching?
indicate if the animals will be used for research or for teaching (add course name and number of
students)
grant
support?
if work is supported by a research or teaching grant, please list funding agency
surgery?
indicate if (and what type of) surgery will be performed
endpoint
note final disposition of animals (e.g. captive colony, adoption, euthanasia & museum donation)
special
briefly note any special circumstances to bring to the attention of the IACUC
I certify that I will follow the provisions for the care, use and treatment of animals as outlined in the NIH “Guide for
the Care and Use of Laboratory Animals”, or the “Guide for the Care and Use of Agricultural Animals in Agricultural
Research and Teaching”. I assure that these procedures do not unnecessarily duplicate previous experiments.
Principal Investigator (1) _______________________________
print
Co-Investigator (2) _______________________________
print
Department / Division Chair: I am aware of this protocol.
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_______________________________
sign
_______________________________
sign
________________________________
sign
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PART 1
name (1)
Principal Investigator / Co-Investigator Information
if more than one investigator is included, list the primary contact person here
email
address
campus
address
campus
phone
emergency
phone
project role
skills,
licenses,
certifications
note qualifications relevant to animal use proposed
other
Co-Investigator Information
name (2)
email
address
campus
address
campus
phone
emergency
phone
project role
skills,
licenses,
certifications
note qualifications relevant to animal use proposed
other
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authors: omit this page if only 1 or 2 investigators are listed, or add additional tables as needed
Co-Investigator Information
name (3)
email
address
campus
address
campus
phone
emergency
phone
project role
skills,
licenses,
certifications
note qualifications relevant to animal use proposed
other
Co-Investigator Information
name (4)
email
address
campus
address
campus
phone
emergency
phone
project role
skills,
licenses,
certifications
note qualifications relevant to animal use proposed
other
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authors: add additional sections for each species as needed
PART 2
Animal Information
species (1)
common name
or strain
number of
individuals
age, weight,
or size
indicate approximate age or age class (by age, weight, or size)
sex
source
indicate source of animals (e.g. provide name of commercial supplier, or site of field capture, etc.)
primary
housing
note building and room number of primary housing site (typically where animals are maintained);
for animals maintained in the CNR Animal Care Facility, simply note “ACF”
secondary
housing
note building and room number of secondary housing site (typically where animals are used)
persons
providing
basic care
provide the name(s) and responsibilities of persons caring for the day-to-day needs of the animals;
for animals in the ACF, simply note “ACF staff”
basic
monitoring
describe the variables that will be monitored, and the frequency of monitoring, during routine
(non-manipulation) housing; for animals in the ACF, simply note relevant SOP
persons
providing
training
provide the name(s) and responsibilities of persons providing training of students or other
personnel who will be caring or using animals under this protocol
persons
conducting
manipulation
provide the name(s) and responsibilities of persons conducting manipulation of animals;
for class use, list course(s) and approximate number of students
experimental
monitoring
describe the variables that will be monitored, and the frequency of monitoring, during periods of
manipulation or experimentation – a separate section for surgery follows in PART 7
persons
providing
health care
endpoint
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provide the name(s) and qualifications of persons who will evaluate, diagnose, and treat
unanticipated discomfort, illness, or injury
note the final disposition of the animals, and outline the procedure(s) for animals that are
unintentionally injured or become ill during the study; expanded descriptions required in 6.3 & 6.4
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PART 3
Objectives of Proposed Research or Instruction
3.1 In clear, concise, non-technical language targeting a general audience, summarize the background,
hypothesis, experimental plan, and relevance of the proposed animal use. If animals are used in teaching, please
provide specific learning outcomes.
PART 4
Rationale for Use of Animals
4.1 In a narrative targeting a general audience, explain why animals are required for your studies.
4.2 Explain why the proposed species is (are) the most appropriate.
4.3 Justify the number of animals used. Describe the statistical tests and/or other rationale for your determination
of the number of animals required, providing references if appropriate.
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4.4 If necessary, how will animals be euthanized? Does this meet the 2013 AVMA euthanasia guidelines? If not,
explain why you are opting to use this method of euthanasia.
PART 5
Alternatives to the Use of Animal & 3R’s
5.1 Explain what alternatives to animal use are available, and explain why the alternatives are not appropriate.
You must also specify at least two sources or databases that you have used to search for alternatives.
Please note that additional guidelines for completing sections 5 & 6 are included in a separate document
entitled << IACUC parts 5 & 6 explained.doc >>. Answers to these questions are required by the National
Institutes of Health for all protocols, as per our agreement as an institution to adhere to NIH guidelines.
If, after reading << IACUC parts 5 & 6 explained.doc >>, you are still unsure how to complete this section,
do not hesitate to call IACUC members.
5.2 Explain how you have met the “3R’s” requirement of Replacement, Refinement, Reduction. Describe the steps
you have taken to replace (some of) the animals used, to refine the use of animals (e.g. by improving technique or
increasing data collection), and to reduce the number of animals or number of procedures.
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PART 6
Experimental Procedures involving Live Animals
6.1 Describe your experimental procedures (outside of normal husbandry) to be performed on these animals.
Identify any nutritional, social, environmental, or physical manipulation of the animals, including the administration
of therapeutic or experimental agents, including dosage, dosing frequency and route of administration, from time
of contact through euthanasia. Note that a separate section follows for description of surgical procedures and details of
anesthesia, analgesia, and surgery should be provided in PART 7.
6.2 Do you anticipate the animals will experience more than momentary or slight pain or
discomfort as a result of your procedure? If YES, describe the methods by which you will
assess, monitor, and minimize pain and distress to the animals. Again, surgical procedures and
monitoring should be addressed in PART 7.
NO
YES
6.3 Describe any potential adverse effects of the experimental procedures and how each abnormal or adverse
effect will be managed. Describe the conditions, criteria, and methods that would lead to the removal of an animal
from the study (e.g. animals with uncontrolled infections would be euthanized) .
6.4 Outline the final disposition of the animals – what will happen to the animals at the end of the study?
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PART 7
Anesthesia, Analgesia, Surgery and Recovery
7.1 Will you be administering anesthesia and/or performing surgery? If YES, complete all of
the questions in this section. If NO, skip to PART 8.
7.2 Who will be administering anesthesia and/or performing surgery?
NO
YES
7.3 If students are participating in anesthesia and surgery, explain how students are trained and supervised.
7.4 Describe the anesthesia and/or surgical procedure, beginning with pre-surgical analgesia (if appropriate),
anesthesia, surgery and recovery. Provide evidence that all surgical procedures will be adequately monitored and
documented. List all the variables monitored during anesthesia, surgery, and immediate post-operative recovery,
or attach a monitoring form. Provide an estimate of the durations of anesthesia, surgery, and recovery.
7.5 Will the animals be allowed to recover? If YES, describe the post-surgical monitoring and
recovery procedures, outline the methods to reduce post-surgical pain or discomfort, and note
the variables that will be used to assess long-term animal health and well-being.
NO
YES
7.6 Will animals undergo more than one major survival surgery? If YES, provide justification
for multiple procedures. A major surgery is one in which a body cavity is opened.
NO
YES
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PART 8
Use of Wild-Caught Animals
8.1 Do you capture, trap, handle or manipulate animals in the wild? If YES, describe the
method of capture, type of equipment, and frequency of monitoring. If NO, skip section.
NO
YES
8.2 Describe the precautions, protections, and/or quarantine procedures taken to limit exposure of personnel to
zoonotic disease or other animal-related injuries or illness.
8.3 Will wild animals be held in captivity for more than 12 hours? If YES, provide a description
of the conditions of captivity, including housing, nutrition, social grouping, and veterinary care.
NO
YES
8.4 Use this space to include any additional information that would help the IACUC understand the particular
requirements of your study.
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UWSP Institutional Animal Care and Use Committee (IACUC)
signature page
Administrative summary information
P.I. name(s)
Project title
Review Date
Protocol #
APPROVED
The undersigned members of UWSP’s IACUC have read your protocol and have found that the
procedures fall within the NIH and USDA Guidelines for the care and use of animals.
DENIED
The undersigned members of UWSP’s IACUC have read your protocol and have found that the
procedures DO NOT fall within the NIH and USDA Guidelines for the care and use of animals.
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