CHARLES STURT UNIVERSITY
ANIMAL CARE AND ETHICS COMMITTEE
WILDLIFE RESEARCH APPLICATION FORM
USE THIS FORM FOR WILDLIFE RESEARCH CONDUCTED IN THE FIELD (E.G., SURVEYS)
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
/
/
Executive Officer, ACEC _____________________________________
__________________
Protocol No.:
__________________
Date:
__________________
NOTE: This form must be typed.
SECTION 1: ADMINISTRATION
1.
TITLE OF PROJECT:
2.
WHAT SPECIES OF ANIMAL WILL BE USED? (FOR SURVEYS THIS MAY BE ALL VERTEBRATES).
GIVE THE SCIENTIFIC AND COMMON NAME (AND, IF APPLICABLE, AGE, SEX AND WIEGHT).
SPECIES
Common Name
Scientific Name
Age
Sex
Weight
List any specific target species.
3.
PRINCIPAL INVESTIGATOR
Where this investigation is part of a student’s research project, their 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.
Name and Designation:
ACEC W1
LAST UPDATED 04.01.16
PAGE 1
School / Section:
School Section Address:
CONTACT DETAILS:
Telephone
Between hours
After hours
Email Address
4.
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 R2). 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)
5.
DESCRIPTION OF RELATIONSHIP OF PRINCIPAL INVESTIGATOR WITH THE INSTITUTION
(Employee, Collaborative Research, Independent of CSU, etc.)
6.
A. HAS AN EXTERNAL ORGANISATION AGREED TO SUPPORT THIS APPLICATION, OR HAS AN
APPLICATION FOR EXTERNAL SUPPORT BEEN LODGED?
Choose one:
Yes 
No

If YES, provide details (i.e., name of the organisation and date of application, and whether the application
has, to date, been successful.)
B. IF A FUNDING APPLICATION IS NOT SUCCESSFUL, WILL THE PROJECT STILL PROCEED?
Choose one:
Yes 
No

7.
A. IS THIS APPLICATION FOR A NEW PROJECT?
Choose one:
Yes 
No


B. IS THIS APPLICATION FOR A PROJECT WHICH BEEN, PREVIOUSLY OR SIMULTANEOUSLY,
SUBMITTED TO THIS OR ANOTHER ETHICS COMMITTEE?
Choose one:
Yes 
No

If YES, provide reasons for resubmission or simultaneous submission, and the name of the AEC or AECs
and approval numbers where appropriate.
C. IS THIS APPLICATION FOR A SIGNIFICANTLY REVISED CURRENT PROTOCOL?
Choose one:
Yes 
No

If YES, quote the approval number, species and number of animals used to date.
ACEC W1
LAST UPDATED 04.01.16
PAGE 2
8.
WHERE IS THE RESEARCH WORK TO TAKE PLACE? DESCRIBE IN RELATION TO THE
NEAREST TOWN.
9.
HAVE THE RELEVANT LICENCES BEEN OBTAINED FROM THE NATIONAL PARKS AND
WILDLIFE SERVICE (NPWS), OR OTHER AUTHORITIES?
Choose one:
Yes 
No

Permit Type and Number:
Dates over which Permit is Valid:
10.
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
Date Authority /
Licence Cancelled
Name of Cancelling
Body
Reason for Cancellation
of Authority / Licence
SECTION 2: JUSTIFICATION FOR ANIMAL USE
AIMS OF THE PROJECT IN LAY TERMS
The Code of Practice states that “Animal experiments may only be performed when the scientific merit
justifies the use of animals”.
Your answer is crucial for the assessment of scientific merit and the necessity of animal use. Use lay terms;
terms that will be understood by a member of the Committee without a scientific background.
11.
DESCRIBE THE AIMS OF THE PROJECT IN LAY TERMS THAT A PERSON WITHOUT A
SCIENTIFIC BACKGROUND WILL UNDERSTAND. SPECIFY WHAT YOU HOPE TO ACHIEVE.
PLEASE GIVE THE BACKGROUND TO THIS PROJECT, WITH A SUPPORTING LIST OF KEY
REFERENCES.
12.
GIVE A BRIEF DESCRIPTION OF THE METHODS USED.
13.
IF THE PROJECT REPEATS PREVIOUSLY-REPORTED EXPERIMENTS, GIVE THE REASONS FOR
THE EXPERIMENTS BEING REPEATED.
ACEC W1
LAST UPDATED 04.01.16
PAGE 3
REASONS FOR ANIMAL USE
14.
IF ANIMALS ARE TO BE CAPTURED, EXPLAIN WHY THIS IS NECESSARY.
WHAT
ALTERNATIVES TO CAPTURING ANIMALS HAVE BEEN CONSIDERED AND WHY ARE THIS
INAPPROPRIATE?
15.
WHAT ADDITIONAL PRECAUTIONS WILL BE TAKEN IF FIELDWORK IS CARRIED OUT DURING
THE BREEDING SEASON, OR IF LACTATING INDIVIDUALS OR ANIMALS WITH DEPENDENT
YOUNG ARE CAPTURED?
SECTION 3: ETHICAL CONSIDERATIONS
AN ASSESSMENT OF THE IMPACT ON ANIMAL WELL-BEING
SEQUENCE OF EVENTS
16.
GIVE DETAILS (SEQUENTIALLY) ON WHAT HAPPENS TO THE ANIMALS(S) FROM THE TIME
THEY ARE CAPTURED UNTIL THE TIME THEY ARE RELEASED.
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.
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”.
Please also consult the ARRP Guideline 10, “Wildlife Survey” guidelines on the ACEC website.
SOP Number
SOP Name
A flow chart or Sequence of Events table may assist in making this information clear.
If any media-related activities arise from this research (for example, photo shoots for newspaper / magazine /
journal features or filming for documentaries or television news features), you will need to advise the Animal
Care and Ethics Committee and submit photographs or filming to the Committee as part of the animal use
associated with this project.
ACEC W1
LAST UPDATED 04.01.16
PAGE 4
IMPACT
17.
WILL THE METHODS DESCRIBED IN THE ANIMAL CARE GUIDELINES FOR WILDLIFE SURVEYS
BY NSW DEPARTMENT OF PRIMARY INDUSTRIES (DPI) BE FOLLOWED TO MINIMISE ON
ANIMALS?
Choose one:
Yes 
No

If NO, give a detailed explanation.
18.
HOW MANY TRAPS WILL BE SET AND OVER WHAT PERIOD OF TIME?
19.
WHAT TRAPS WILL BE USED?
If using Mist Nets, please provide details of experience and training in use. If Pitfall Traps are to be used, the
Guidelines for the Use of Pitfall Traps by NSW DPI must be followed.
20.
HOW OFTEN AND AT WHAT TIMES WILL TRAPS BE CHECKED AND / OR CLEARED?
21.
DESCRIBE ANY OTHER METHODS TO BE USED FOR CAPTURE.
22.
WHAT PRECAUTIONS WILL BE TAKEN IN THE EVENT OF INCLEMENT WEATHER?
23.
WILL SAMPLES BE TAKEN?
(Milk, Scales, etc.)
Choose one:
Yes
No


If YES, give details.
24.
HOW WILL ANIMALS BE HANDLED OR RESTRAINED?
25.
IS TRANSPORTATION NECESSARY?
Choose one:
Yes 
No

If YES, describe how animals will be transported, over what period of time and what precautions will be
taken against cold / heat / stress, etc.,
ACEC W1
LAST UPDATED 04.01.16
PAGE 5
26.
HOW WILL ANIMALS BE INDIVIDUALLY IDENTIFIED?
27.
WHAT, IF ANY, ADVERSE EFFECTS WILL THERE BE ON THE ANIMALS IN RELATION TO ALL
THE PROCEDURES YOU WILL CARRY OUT?
28.
IF INVASIVE METHODS ARE TO BE USED, HOW WILL PAIN / DISTRESS BE MINIMISED?
29.
WILL ANY RADIO-TRACKING COLLARS OR OTHER RADIO-TRACKING EQUIPMENT BE USED?
Choose one:
Yes 
No

A. If YES, describe what equipment will be used on the animal, how it will be attached, how much the
equipment weighs and the impact on the animal.
B. How will the equipment be retrieved?
ANIMAL MONITORING
30.
WHO WILL MONITOR THE ANIMALS?
NAME
QUALIFICATIONS
EXPERIENCE WITH SPECIES USED
31.
HOW WILL THE ANIMALS BE MONITORED DURING CAPTURE, HANDLING AND POSTRELEASE?
32.
WILL ANIMALS BE HOUSED?
If YES, justify why animals need to be housed, and be not be released immediately, and answer questions A –
C below.
A. How will the animals be housed (including whether housed separately or not)?
B. What will be the duration of housing?
C. What will the animals be fed, and how often, whilst housed?
ACEC W1
LAST UPDATED 04.01.16
PAGE 6
EMERGENCIES
33.
IDENTIFY POSSIBLE EMERGENCIES WHICH MAY ARISE DURING THIS PROJECT
(animal injured in a trap, bushfire, hailstorm, etc.)
34.
LIST THE PROCEDURES YOU HAVE IN PLACE TO DEAL WITH THESE EMERGENCIES,
INCLUDING EMERGENCY CONTACTS IN THE FIELD
(contact number of local veterinary surgeon, etc.)
If the animal or animals need to be euthanased, please refer to question 40 below.
RE-USE
35.
DOES THIS PROJECT INVOLVE THE USE OF ANY ANIMALS OR FAUNA SURVEY SITES THAT
HAVE BEEN THE SUBJECT OF PREVIOUS RESEARCH?
Choose one:
Yes 
No

If YES, what has previously been done to these animals? Include the project name(s) and identification
number(s).
FATE OF ANIMALS
36.
WHAT WILL HAPPEN TO THE ANIMALS AT THE COMPLETION OF THE PROJECT?
37.
WILL VOUCHER SPECIMENS BE TAKEN?
Choose one:
Yes 
No

If YES, please answer questions A – C below.
A. Provide justification for the taking and the number of voucher specimens.
B. Where will the voucher specimens be lodged?
C. Will Collection of Voucher Specimens by the Department of Primary Industries be followed?
Choose one:
Yes 
No

If NO, provide a detailed explanation.
38.
WHAT WIL HAPPEN TO ANY NON-TARGET SPECIES CAPTURED DURING THE COURSE OF THIS
PROJECT?
(feral animals, carp, etc.)
ACEC W1
LAST UPDATED 04.01.16
PAGE 7
39.
IF ANIMALS ARE TO BE EUTHANASED:
A. What method of euthanasia will be used?
B. Where will euthanasia be carried out?
C. Who will do it, and what is their experience in the technique to be employed?
TECHNICAL
40.
LIST THE QUALIFICATIONS AND EXPERIENCE OF ALL PERSONNEL WHO WILL BE
PARTICIPATING IN THE ANIMAL COMPONENTS OF THE PROJECT. DETAIL WHETHER THE
EXPERIENCE IS WITH THE SPECIES BEING USED, AS WELL AS WETHER THE EXPERIENCE IS
WITH THE PROCEDURES BEING UNDERTAKEN.
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 & Qualifications
Experience in
procedures to be
undertaken and the
species being used.
If no experience,
describe how relevant
experience will be
obtained
Contact Details:
- work phone no.
- home phone no.
- email address
Principal Investigator
Associate Investigator(s)
Other participants
SECTION 4: DECLARATION OF RESPONSIBILITIES
DECLARATION BY THE PRINCIPAL INVESTIGATOR
I certify that the use of animals in this project will conform with the NSW legislation and the general principles of the
NHMRC / CSIRO / AAC 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.
I confirm that all 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.
ACEC W1
LAST UPDATED 04.01.16
PAGE 8
Principal Investigator:_________________________________________
(Signature)
Date: ______________________
(Print Name)
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: 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
ACEC W1
LAST UPDATED 04.01.16
PAGE 9
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
ACEC W1
LAST UPDATED 04.01.16
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
PAGE 10