CHARLES STURT UNIVERSITY
ANIMAL CARE AND ETHICS COMMITTEE
APPLICATION FOR THE USE OF ANIMALS FOR TEACHING PURPOSES
This application form is restricted to proposals for teaching (practical sessions) as part of the requirements of a specific
subject. A separate application must be submitted for each practical class 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:
/
/
ACEC Agenda Item No.:
to
/
/
__________________
Protocol No.:
_________________
Date:
__________________
Executive Officer, ACEC _____________________________________
NOTE: This form must be typed.
1.
SUBJECT CODE AND NAME
You are required to enter the Subject Name as well as the Subject Code
Description of Teaching Activity
(animal handling, physiological experiments with rats and mice, etc.)
2.
NUMBER OF STUDENTS ENROLLED
Internal Students
External Students
3.
MAXIMUM NUMBER OF STUDENTS TO BE SUPERVISED BY EACH TEACHER
4.
NAME AND DESIGNATION OF CHIEF INSTRUCTOR
CONTACT DETAILS:
School or Section
School or Section address
Telephone
Between hours
After hours
Email Address
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5.
SUPERVISORY PERSONNEL (INCLUDING UNIVERSITY ACADEMIC AND TECHNICAL STAFF)
Position
6.
Title
Name
Qualifications
DATES FOR APPROVAL (use DD/MM/YY format)
If your teaching project is span multiple days, or if it is likely that it will need to be repeated due to adverse
circumstances for the proposed teaching program, please ensure that the dates for which approval is requested
encompass an appropriate timeframe. PLEASE NOTE THAT TEACHING ACTIVITIES INVOLVING ANIMALS MAY
ONLY BE CONDUCTED WITHIN THE TIMEFRAMES APPROVED BY THE ANIMAL CARE AND ETHICS
COMMITTEE.
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)
7.
ANIMALS TO BE STUDIED
SPECIES
8.
Scientific Name
Breed / Strain
Sex
NUMBER
TO BE USED
PER YEAR
ORIGIN OF ANIMALS
DECLARATION BY MANAGER, ANIMAL HOUSE / MANAGER, HOLDING FACILITY:
Please cross out the sections below that do not apply
I confirm that housing is available in the Animal House / Holding Facility for the number of animals
requested for the teaching period nominated, and that the Animal House / Facility staff can provide
adequate maintenance and care of the animals during that time
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OR
Housing will be available for _______ animals in the Animal House / Holding Facility for the teaching period
nominated. Additional housing will be provided at:
_________________________________________________________________________________
There will be staff at both facilities to provide adequate maintenance and care of the animals during that
time.
OR
Housing and staff to provide adequate maintenance and care of the animals are not available in the Animal
House / Holding Facility for the animals requested during the teaching period nominated.
Name:
_______________________________________________________
Signed:
_______________________________________________________
Animal House / Facility name: ____________________________________________________________
Date:
_______________________________________________________
DECLARATION BY CHIEF INSTRUCTOR:
I have personally inspected the animal housing / holding facility to be used during this teaching project, and
I am satisfied in regard to the smooth running of the housing facility for the duration of the project.
Signature:
9.
10.
_______________________________________________________
LOCATION WHERE TEACHING PROJECT IS TO BE CONDUCTED:
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

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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
Date Authority /
Name of Cancelling
Reason for Cancellation
Member
Licence Cancelled
Body
of Authority / Licence
11.
A. USE OF ANIMALS (PLEASE CHECK THE BOX AGAINST AGAINST THE APPLICABLE
CATEGORY)
Dissection
Feeding Experiments
Behaviour Experiments
Physiological Experiments
Pharmacological Experiments
Immunological Experiments
Other (please specify)
B.
i)
JUSTIFICATION FOR THE NUMBER OF ANIMALS TO BE USED
ii)
WHAT STEPS HAVE YOU TAKEN TO “REDUCE, REFINE OR REPLACE”?
C. JUSTIFICATION FOR THE USE OF ANIMALS IN TERMS OF BENEFIT TO THE TEACHING
PROGRAM
D. WHAT NON-ANIMAL ALTERNATIVES HAVE BEEN CONSIDERED? EXPLAIN WHY IT IS NOT
POSSIBLE TO USE THESE AND WHY THEY ARE NOT APPROPRIATE.
E. HAVE ANY ANIMALS TO BE USED IN THIS PROJECT BEEN THE SUBJECT OF PREVIOUS
RESEARCH OR TEACHING PROGRAMS?
Choose one:
Yes 
No

Unknown

If YES, give justification for use of these animals in this program:
F.
i)
PLEASE INDICATE THE MINIMUM AND MAXIMUM NUMBER OF ANIMALS TO BE USED
BY EACH STUDENT
Minimum
Maximum
ii)
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PLEASE INDICATE THE MAXIMUM NUMBER OF TIMES EACH ANIMAL WILL BE USED
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12.
PERSONNEL
Indicate person(s) responsible for procedures used on animals (eg., euthanasia). Please tell the Committee
what experience the person has relevant to the procedure to be performed, and how many years’ experience in
that field that nominee has.
Name
13.
Qualifications and Experience
Procedure
WILL STUDENTS PERFORM EXPERIMENTS / PROCEDURES?
Choose one:
Yes 
No

If YES, who will instruct students in procedures to be carried out? Indicate experience of the instructor in the
application of these techniques.
14.
HOW WILL THE ATTAINMENT OF THE EDUCATION OBJECTIVES BE ASSESSED?
15.
OUTLINE THE TREATMENT OF ANIMALS BEFORE, DURING, AND AFTER USE.
Factors 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.
Where possible, attach a protocol of procedures to be used.
Include detail on the location and care of animals during the proposed period. ALL procedures MUST be in
accordance with the prescribed Code of Practice under the Animals Research Act 1985 (NSW) and Animal
Research Regulation 1995.
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
16.
SOP Name
A. JUSTIFY ALL PROCEDURES WHICH HAVE THE POTENTIAL TO CAUSE PAIN OR DISTRESS
B. DETAIL STEPS TO BE TAKEN TO AVOID OR MINIMISE THE PAIN OR DISTRESS
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17.
WHO WILL MONITOR THE ANIMALS A. During weekdays?
Please tell the Committee what experience the person has relevant to care of the species to be used in the
project, and how many years’ experience with those animals that nominee has.
NAME
QUALIFICATIONS
EXPERIENCE WITH SPECIES USED
B. At night (If applicable)?
Please tell the Committee what experience the person has relevant to care of the species to be used in the
project, and how many years’ experience with those animals that nominee has.
NAME
QUALIFICATIONS
EXPERIENCE WITH SPECIES USED
C. During weekends and holidays?
Please tell the Committee what experience the person has relevant to care of the species to be used in the
project, and how many years’ experience with those animals that nominee has.
NAME
QUALIFICATIONS
EXPERIENCE WITH SPECIES USED
18.. DESCRIBE HOW THE ANIMALS WILL BE MONITORED
A. While the procedures are being carried out.
Include frequency and methods used.
B. For the duration of the project.
Include frequency and methods used.
19.
A. METHOD(S) OF DISPOSAL OF ANIMALS ON COMPLETION OF PROGRAM(S)
B. EUTHANASIA OF ANIMALS
Where animals are to be euthanized for preparation of whole animal or tissue specimens, or at the
conclusion of experimentation, or due to an unforeseen injury, provide details of the method of
euthanasia, eg., cervical dislocation, carbon dioxide asphyxiation, anaesthetic overdose, other.
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Euthanasia of any animals under these circumstances is to be reported to the Animal Care and Ethics
Committee within forty0eight (48) hours.
For cervical dislocation, give details of the experience of the person carrying out of the procedure. For anaesthetic overdose,
indicate which anaesthetic will be used and give details of route of administration and dose rate.
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
How is death confirmed?
What material, if any, is to be collected?
20.
DESCRIBE STEPS TO BE TAKEN TO ENSURE THE SAFETY AND HEALTH OF SURVIVING
ANIMALS IN THIS PROGRAM
21.
ARE THERE ANY FEATURES OF THE PROPOSAL WHICH RAISE SPECIAL ETHICAL
CONSIDERATION?
Choose one:
Yes 
No

If YES, give details.
22.
HAS AN APPLICATION BEEN MADE TO ANY OTHER ANIMAL ETHICS COMMITTEE TO
CONDUCT THE SAME PROJECT, OR ANOTHER SUBSTANTIALLY SIMILAR?
Choose one:
Yes 
No

If YES, please indicate who the other Animal Ethics Committee is, and the name / nature of the project:
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
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offence to conduct experiments unless approval in writing from the University’s Animal Care and Ethics
Committee (ACEC) has been received.
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:__________________________________
(Signature)
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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