CHARLES STURT UNIVERSITY
ANIMAL CARE AND ETHICS COMMITTEE
PRACTICAL CLASS FIELDWORK PROPOSAL FOR ANIMAL USE
This application form is restricted to proposals for fieldwork (practical sessions) involving students under staff supervision, in
collecting and releasing live animals (vertebrate only) as part of the requirements of a specific subject. If animals are to be
retained then either form ACEC R1, ACEC W1 or ACEC T1 should be used.
A SEPARATE APPLICATION MUST BE SUBMITTED FOR EACH PRACTICAL CLASS FIELDWORK PROPOSAL.
To expedite resolution of any minor issues raised by the ACEC during consideration of your application, please
provide a landline telephone contact number appropriate for the duration of the relevant ACEC meeting.
Alternatively you are welcome to speak to your application at the meeting. If you wish to address the meeting,
please contact the ACEC’s Executive Officer on 6338 4773.
Telephone Number:
OFFICE USE ONLY
Date Received:
/
/
Period of Approval:
/
/
to
/
ACEC Agenda Item No.:
__________________
Protocol No.:
__________________
/
Executive Officer, ACEC _____________________________________
Date:
__________________
NOTE: This form must be typed.
SECTION 1: ADMINISTRATION
1.
SUBJECT CODE AND NAME
Description of Fieldwork Activity
(animal handling, physiological experiments with rats and mice, etc.)
2.
NUMBER OF STUDENTS INVOLVED
Internal Students
External Students
3.
NAME AND DESIGNATION OF CHIEF INSTRUCTOR
Where this investigation is part of a student’s research project, the Principal Supervisor must be nominated on this form as the
Principal Investigator. Other participants (including students) must be listed in the appropriate section of the form.
CONTACT DETAILS:
School or Section
School or Section address
Telephone
Between hours
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After hours
Email Address
4.
SUPERVISORY PERSONNEL (INCLUDING UNIVERSITY ACADEMIC AND TECHNICAL STAFF)
Please tell the Committee what experience the person has relevant to any procedure to be performed, and how
many years’ experience in that field that nominee has.
Position
5.
Title
Name
Qualifications and
Experience
DATES FOR APPROVAL (Use DD/MM/YY format)
From:
To:
For ongoing work where methodology does not change, you may apply for an approval period of up to
three (3) years after the proposed commencement date, as the ACEC can approve ongoing projects for
up to 3 years subject to receipt of annual reports (ACEC T2). Please note that Annual Review
Forms are required under the Australian Code for the Care and Use of Animals for Scientific
Purposes (2.4.34)
6.
ANIMALS TO BE STUDIED
If native mammals are to be the focus of the study, please identify the target species specifically, i.e., macropods, possums / gliders,
native rats / mice, dasyurids, wombats, koalas, monotremes, bandicoots, bats, other. Please also be specific should any feral animal
be the focus of the study. This will enable the ACEC to provide accurate data to the Department of Primary Industries each year in
its annual report.
SPECIES
7.
Common Name
Scientific Name
NUMBER
TO BE USED
PER YEAR
HAS AN APPLICATION BEEN MADE TO ANY OTHER ANIMAL ETHICS COMMITTEE TO
CONDUCT THE SAME PROJECT, OR ANOTHER SUBSTANTIALLY SIMILAR?
Choose one:
Yes 
No

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If YES, please indicate who the other Animal Ethics Committee is, and the name / nature of the project:
8.
HAVE ANY ANIMALS TO BE USED IN THIS PROJECT BEEN THE SUBJECT OF PREVIOUS
TEACHING PROGRAMS?
Choose one:
Yes 
No

If YES, give identify which animals and the nature of the previous teaching work (i.e., spotlighting
identification, trapping and release, etc.)
9.
10.
LOCATION OF FIELDWORK STUDY (PLEASE PROVIDE SPECIFIC DETAILS):
HAS PERMISSION BEEN GRANTED TO CAPTURE ANIMALS IN THE STUDY SITE?
Choose one:
Yes 
No

If YES, please provide details. If NO, please explain why permission has not been granted:
11.
A. ARE LICENCES REQUIRED?
Choose one:
Yes 
No

If YES, do the Supervising staff have the appropriate licences?
Choose one:
Yes
No


If a current licence is not held and is required, then any approval will be subject to the ACEC being notified of receipt of a
licence and advised of the type of licence, licence number and licence expiry date. The study may not commence without a
licence.
PROVIDE DETAILS
Staff Member
Type of Licence
Licence Number
Expiry Date
B. HAVE ANY OF THE PEOPLE PARTICIPATING IN THE PROJECT HAD ANY ANIMAL
RESEARCH AUTHORITY OR ANIMAL SUPPLIER’S LICENCE CANCELLED?
Choose one:
Yes 
No

If YES, please provide details including the name of the person, the date on which the authority or licence
was cancelled, who cancelled the authority and the reason for cancellation:
Name of Staff
Member
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Date Authority /
Licence Cancelled
Name of Cancelling
Body
Reason for Cancellation
of Authority / Licence
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SECTION 2: ANIMAL USE
JUSTIFICATION FOR THE USE OF ANIMALS
12.
JUSTIFICATION FOR NUMBER OF ANIMALS TO BE USED
13.
JUSTIFICATION FOR USE OF ANIMALS IN TERMS OF BENEFIT TO THE TEACHING PROGRAM
14.
WHAT NON-ANIMAL ALTERANTIVES HAVE BEEN CONSIDERED? EXPLAIN WHY THESE
CANNOT BE USED IN PLACE OF ANIMALS.
CAPTURE AND RELEASE
Aspects may include handling, housing, etc., as well as specific procedures. Refer to the CHECKLIST at the end of this application form to
ensure all details have been considered and refer to published Standard Operating Procedures where appropriate).
15.
PLEASE PROVIDE DETAILS OF THE CAPTURE TECHNIQUES TO BE USED:
All procedures must be in accordance with the Code of Practice prescribed in the Regulation and or /
conditions imposed by the ACEC.
Please list any Standard Operating Procedures which are to be used – please refer to the ACEC Register of
Standard Operating Procedures on the ACEC website for a complete list of Standard Operating Procedures
(SOPs) already approved by the Animal Care and Ethics Committee. If you are submitting a new Standard
Operating Procedure for approval by the Committee, please insert “None- New for Approval” under “SOP
Number”.
SOP Number
SOP Name
16.
WILL STUDENTS BE INVOLVED IN CAPTURING ANIMALS?
Choose one:
Yes 
No

16.
A. JUSTIFICATION FOR ALL TECHNIQUES / PROCEDURES WHICH HAVE THE POTENTIAL TO
CAUSE PAIN OR DISTRESS
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B. DETAIL STEPS TO BE TAKEN TO AVOID OR MINIMISE THE PAIN OR DISTRESS
17.
EUTHANASIA OF ANIMALS IN CASE OF AN UNFORESEEN INJURY
In the event of an unforeseen incident that requires euthanasia of an animal, I declare that this will
be performed humanely by a registered veterinarian. If not, the alternative I propose is set out
below:
(A blank space below, with just a signature, will be taken as assent with this clause)
......................................................................................................................
Signature
18.
WILL ANIMALS BE RELEASED AT THE END OF THE STUDY?
Choose one:
Yes 
No

If NO, provide details explaining the fate of the animals. If live animals are to be retained, a separate
application must be submitted on form ACEC R1 or ACEC T1.
19.
ARE THERE ANY POTENTIAL HEALTH RISKS TO EITHER HUMANS, ANIMALS SURVIVING THE
PROGRAM OR OTHER ANIMALS?
Choose one:
Yes 
No

If YES, please describe the risk and what steps you have in place to protect the group at risk.
20.
ARE THERE ANY FEATURES OF THE PROPOSAL WHICH RAISE SPECIAL ETHICAL
CONSIDERATION?
Choose one:
Yes 
No

If YES, give details.
DECLARATION OF RESPONSIBILITIES
A.
Declaration by Subject Co-Ordinator
I certify that the use of animals in this project will conform with the NSW legislation and the general
principles of the NHMRC / CSIRO / ARC / AVCC Australian Code for the Care and Use of Animals for
Scientific Purposes. I accept responsibility for the conduct of all procedures detailed in this application
and for the supervision of all personnel delegated to perform any such procedures and understand it is an
offence to conduct experiments unless approval in writing from the University’s Animal Care and Ethics
Committee (ACEC) has been received.
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I confirm that all supervisory personnel have read this application and have agreed to comply with
procedures described and any conditions imposed by the ACEC.
I confirm that I have taken into account potential hazards to staff working with animals in this project,
and have ensured that appropriate safety measures have been implemented.
Subject Co-Ordinator:____________________________________
(Signature)
Date: ____________________
(Print Name)
B.
Declaration by Head of School / Section (as applicable)
I have read this application and am satisfied that the use of animals is justified on scientific, educational
or diagnostic grounds.
Head of School / Section:__________________________________
Date:_____________________
(Print Name)
School / Section:_________________________________________
SUBMIT THIS FORM TO:
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The Executive Officer, Animal Care and Ethics Committee
Office of Governance and Corporate Affairs
Charles Sturt University – Bathurst campus
Building 1294-L3
Email: animalethics@csu.edu.au
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CHECKLIST



Anaesthesia
 Fasting
 Induction – drug, dose, route
 Maintenance – drug, dose, route
 Methods of monitoring
What is happening to the animals?
What will be the effects?
How will the effects be minimised?
Euthanasia
 Method
 Location (where procedure will
be performed)
 Expertise of personnel
anaesthesia and recovery
 Additional support during
anaesthesia and recovery (e.g.,
heat, intravenous fluids)
 Location of induction and
recovery areas
Behaviour Modification
 Stimulus (type, duration,
frequency)
Blood / Body Fluid Collection
 Volume
 Route
 Frequency
 Anaesthesia or analgesia
 Restraint
 Animal monitoring (methods &
frequency)
Diet / Water Modifications
 Type
 Amount
 Effects
 Measurement of Intake
 Animal Monitoring
Drug Treatments








Substance
Volume
Route
Frequency / total number per
animal
Local and systemic effects
Anaesthesia or analgesia
Possible side effects
Restraint
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Genetic Manipulation
 Methods
 Potential effects
Housing
 Location
 Group housing (stocking rates,
sexes)
 Isolation
 Shelter
 Bedding
 Hiding areas
 Environmental enrichment
 Duration held
 Conditioning period
In-vitro Studies
 Source of animals
 Duration held
 Euthanasia
Surgery
 Anaesthesia
 Location of pre-operative
preparation area
 Surgical procedure (site,
technique)
 Sterile technique (instruments,
drapes, surgeon)
 Location of and housing in postoperative recovery area
 Post-operative management
 Post-operative monitoring
(methods, frequency, duration)
 Use of analgesics (type, dose,
route, frequency, means of
determining necessity for use)
 Expertise
Toxicology
 Substance
 Volume
 Route
 Frequency of treatments /
Total number per animal
 Local and systemic effects
 Anaesthesia or analgesia
 Restraint
 Animal monitoring (methods and
frequency
 Endpoint / duration
 Tumour / neoplasia induction
 Method
 Site
 Endpoint
 Animal monitoring (methods,
frequency
Transport
 Type
 Duration
 Confinement
 Numbers of animals
 Air conditioning
Teaching
 Source of animals
 Housing
 Duration held
 Method of disposal
Wildlife Studies
 Location
 Methods
 Capture methods
 Handling methods
 Handling / restraint
 Housing / holding
 Monitoring
 Release
 Effects on population
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