NORTHERN ARIZONA UNIVERSITY
IACUC Protocol Annual Review
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IACUC PROTOCOL NUMBER _____________
ANNUAL REVIEW________ FINAL REVIEW_______
PROTOCOL APPROVAL DATE _________
PROTOCOL TITLE:
PRINCIPAL INVESTIGATOR:
Note: Use this report only to provide the annual or final report of protocol activity. Do not use this form to
request changes in the original protocol. For such requests, use the NAU IACUC Modification Request Form.
I. Animal Use: The investigator should report the number of animals used in this protocol since the last
annual report. Include species, common name, gender and USDA pain category.
SPECIES
____
COMMON NAME
SEX
NUMBER
USDA PAIN CATEGORY
__________
___
_____
_________
II. Project Summary: In lay terms, provide a brief synopsis (1 page or less) of study activities and results for
the past year.
III. Problems Encountered: Describe any health problems, accidental deaths, or other animal welfare issues
encountered in this reporting period for this study and describe how those problems were addressed.
IV. Personnel Training: Please attach a copy of your laboratory training form for all new personnel on the
project and/or training for new techniques or procedures approved since the last annual report.
401288400/Final 9-2014 Page 1 of 2
NORTHERN ARIZONA UNIVERSITY
IACUC Protocol Annual Review
SECTION IV: APPROVALS AND CERTIFICATIONS
I certify that, to the best of my knowledge, the information included herein is accurate and complete. I
understand that should the conduct of the protocol require a material change from that stated herein,
approval by the IACUC is required before I may proceed to implement the change.
Principal Investigator
Signature
Date
Office use only
IACUC ACTION:
Reviewed without comments
Call for committee review
SIGNATURES:
IACUC Chair
IACUC Veterinarian
401288400/Final 9-2014 Page 2 of 2
Modifications required finalize review
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