Animal Ethics Committee Ethics Variation for Research Involving Animals ~ VARIATION FORM ~ NOTES: What is a variation? A variation is any change made to your originally approved research protocol. Variations may include, but are not limited to, extensions of time, changes of titles, additions to the research, or changes to researchers Variations must be approved by the AEC before they are implemented. When you should use this form. For requesting approval for a proposed variation to your original research project which has previously been approved by the University of New England’s Animal Ethics Committee (AEC). Care should be taken in the preparation of the variation, ensuring that you answer all questions relevant to your application to vary the existing, approved protocol. If you are a Mac user, please be aware that the ‘check boxes’ may not be compatible with your computer and you will therefore be required to put an ‘X’ next to the appropriate box. Answers to questions must be: Entered into the spaces provided – these can be expanded if you require more room, although answers should be kept as concise as possible while at the same time providing the required detail. All answers must be typed using a font size no smaller than Georgia 10pt or similar. Submission: Variation forms should be submitted to the address below by the closing date of the next meeting. It is advised that you retain a copy for your files. Research Ethics Officer Research Services T.C Lamble Building The University of England Armidale NSW 2351 02 6773 3449 02 6773 3543 ethics@une.edu.au PLEASE DO NOT SUBMIT THIS PAGE WITH YOUR VARIATION 13/04/2016 Animal Ethics Committee Ethics Variation for Research Involving Animals ~ VARIATION FORM ~ Variation Request for an Extension /Amendment/Variation or Addition/Deletion of Staff/Students to an already, approved protocol Authority Number: AEC Project Title: Principal Investigator: 1. 2. 13/04/2016 Type of Variation Requested Time Extension Extra Animals Adding New Personnel Removing Personnel Changing Procedure Other Provide details of the variation including justification as to why it is necessary to the approved protocol. 3. Nature of Procedural Modification. Please provide both the question number on the original application that the change relates to as well and the original wording on the question. Question No. Previous submission wording Proposed amendment 4. If the previously indicated end date needs extending, please indicate the new end date and why the project has been prolonged. 5a. If changes to animal numbers are required, detail the number of each strain or species of animals originally approved. Species No. Strain 5b. Common Name Purpose Procedure Total List the requested number of each strain or species of animals now needed. Species No. Strain 13/04/2016 Total List the number of each strain or species of animals used to date. Species No. Strain 5c. Common Name Common Name Purpose Procedure Total 6. Provide details of any additional personnel to be listed on the protocol: Name (eg Dr John Smith) (one name only) UNE Staff Number Qualifications School Mailing Address Phone No. Fax No. Email Address Role in this project Experience relevant to this project Copy this table and repeat for any additional personnel. Specify for each person added above their level of experience with the procedures and animals being used in this protocol if they have no experience, describe how the relevant experience will be obtained. a) Have any of the nominated researchers ever had a research authority cancelled? No Yes If yes, please state which researchers. b) Have all the nominated researchers completed an Animal Ethics course or similar Yes No training? If no, please state which researchers have not. The researchers are reminded that this course must be completed before the research begins. 13/04/2016 7. Deletion of personnel listed on the approved protocol: List all personnel to be removed from the protocol 8. Does this request involve changes to the location Yes No If ‘Yes’ please provide details and justification. If ‘Yes’ have you confirmed with the facility Manager that the facility is available No Yes (Please do not submit this request until you have received this confirmation). 9. Other changes not specified above. Provide details and justification. ffffff 10. Do any of these changes involve/introduce the use of genetically modified organisms? No Yes If ‘Yes’ please provide details 13/04/2016 11. Will this change/alter the risks or ethical issues associated with the study? Yes No Yes No Yes No If ‘Yes’ please provide details. 12. Will this alter the benefits associated with the study? If ‘Yes’ please provide details. 13. Will this variation require permissions or approvals from other authorities? If ‘Yes’ please provide details. Declaration In signing this variation request I/we declare that I/we have read the application and approval notice for the approved protocol, agree to abide by the requirements of the Declaration of Responsibility and that the variation will not be implemented until approval has been received from the AEC. Print Name Principal Investigator Associate(s): 13/04/2016 Signature Date