ANNUAL REVIEW FORM
INSTRUCTIONS
The following annual review must be completed and returned for consideration by the IACUC
Committee. Please be aware that under IACUC procedures you must have this AUP approval
renewed each year and a complete review is required every 3 years during the term of your
experimental study. Triennial Reviews (3rd year) will require the submission of a “new” AUP.
The ULAC Committee bases the review dates on the approval date of the AUP.
Please fill out the investigator information on page 1. The IACUC office will notify you by email of the AUP number that needs review. Some questions must be answered. Special
attention should be paid to:
•
•
Number of animals used to date (Section 1).
Sections 5 and 6. Please answer Section 5. Note that if the answer to Section 6 is Yes
OR No, a description must be provided as to the methods used to determine this answer.
If you have any questions, please contact, (research@pvamu.edu) or Quincy Moore
(qcmoore@pvamu.edu).
Please return the form to the IACUC, c/o Research Regulatory Compliance Office, Delco, Room
133, (research@pvamu.edu). The original document with original signature must be submitted
for approval.
PRAIRIE VIEW A&M UNIVERSITY - INSTITUTIONAL ANIMAL CARE
AND USE COMMITTEE
ANNUAL REVIEW FORM
Date:
Investigator:
Department:
P.O. Box:
AUP#:
Title:
1. RECORD OF ANIMAL USE
Species
Total #
Approved
# Used to
Date
(year 1)
(year 2)
(year 3)
2.
PROTOCOL STATUS. Please indicate by marking the status of this project..
Request Protocol Continuance
A. ____
B. _____
C. _____
D. _____
Active - project ongoing.
Currently inactive - project was initiated but is presently inactive.
Inactive - project was never initiated but anticipated start date is _____
Inactive - project pending sponsor award
Request Protocol Termination
E. _____
F. _____
G. _____
IF F or G:
Inactive - project never initiated
Currently inactive - project initiated but project has not/will not be
completed
Completed - no further activities with animals will be done.
_____ No animals remain in PVAMU facilities on this AUP number.
_____ Remaining animals on this AUP number have been transferred to:
3.
FUNDING SOURCE Specify the funding source:
4.
PROJECT PERSONNEL
Have there been any personnel/staff changes since the last ULACC approval was granted?
_____ No
______ Yes
If yes, please complete the following sections (Additions/Deletions). For additions,
please state training/experience and make arrangements with the Training Office at
LARR for training on the proper care and handling of laboratory animals.
Additions:
Name / Role / Responsibility for Project / Training
____________________________________________________________
____________________________________________________________
____________________________________________________________
Deletions:
Name
Effective Date
____________________________________________________________
____________________________________________________________
____________________________________________________________
Have any of the previously approved personnel received additional training in animal care or
occupational health and safety?
Name
Training
____________________________________________________________
____________________________________________________________
5.
PROBLEMS/ADVERSE EVENTS (THIS QUESTION MUST BE ANSWERED)
If the status of this project is 1A (Active - project ongoing) or 1B (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.
None
6.
ALTERNATIVES TO POTENTIALLY PAINFUL PROCEDURES
Procedures that cause the least amount of pain or distress to animals should be considered and used
whenever possible. If this project includes procedures which could reasonably be expected to cause
more than slight or momentary pain or distress, have alternatives which are potentially less painful or
distressful become available since the last approval of this AUP that could be used to achieve your
specific project aims?
____ N/A
Section III.D.2. of the AUP was answered “NO”
____ YES
If yes, please describe the alternatives you have initiated with appropriate amendment (if
not submitted previously.)
____ NO
If no, describe the methods and sources you used to determine that alternatives to these
procedures are not available. These might include computerized database searches (e.g.,
Medline).
7.
PROPOSED CHANGES
Any proposed change in personnel, species usage, animal procedures, anesthesia, post-operative care, or
biohazard procedures to the animal portion of a study must be reported in writing to the ULACC/IACUC
for approval. Committee approval of the proposed changes is required prior to proceeding with the
revised animal procedures.
[Please note that if the modifications are significant, you may be required to complete a new AUP]
___
No changes are planned and the project will continue as previously approved by ULACC.
_____
Minor changes are planned. Enclosed is a memo requesting the modifications.
_____
Major changes are planned. Enclosed is a revised AUP addressing the next
__________ year(s) proposed research.
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 certifies that the investigator will continue to conduct the project in full compliance
with the aforementioned requirements. Signature further certifies that the proposed work does not
unnecessarily duplicate previous experiments.
_______________________________________
Signature - Principal Investigator
______________
Date
FOR COMMITTEE ACTION ONLY
___________________________________________
Approval Signature
_______________
Date