FSU IACUC Annual Review Form
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AUP #____
Frostburg State University
Institutional Animal Care and Use Committee (IACUC)
ANNUAL REVIEW FORM
You must have your Animal Use Protocol (AUP) approval renewed annually for research
and teaching activities involving use of animals. This form must be completed and
returned to the Office of Research and Sponsored Programs for consideration by the FSU
IACUC at least 30 days prior to the expiration of your AUP. A complete review is
required every 3 years and requires the submission of a new “Protocol Form for Use of
Vertebrate Animals in Research and Education” form.
Please fill out all of the information on the following pages. Special attention should be
paid to:


Number of animals used to date (Section 1).
Sections 5 and 6. Please answer Section 5. Note that if the answer to Section 6 is
Yes OR No, a description must be provided as to the methods used to determine this
answer.
If you have any questions, please contact Dr. Erica Kennedy (Psychology, x4206) or Dr.
Karen Keller (Biology, x4174), IACUC Co-Chairs. Please return this form to the Office
of Research & Sponsored Programs. You may submit this form electronically (to
dwebb@frostburg.edu), however you must also send a paper copy with your signature.
Date:____________________
Investigator:_____________________________________________________________
Department:_________________________________
Title of Project:___________________________________________________________
Date of Original Approval:
FSU IACUC Annual Review Form
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1. RECORD OF ANIMAL USE
Species
Total # Approved
# Used to Date
2. PROTOCOL STATUS. Please mark an “X” in one of the following categories.
Request Protocol Continuance
A. ______
B. ______
C. ______
D. ______
Active – project ongoing.
Currently inactive – project was initiated but is presently inactive.
Inactive – project was never initiated but anticipated start date is _______.
Inactive – project pending funding.
Request Protocol Termination
E. ______
F. ______
G. ______
Inactive – project never initiated.
Currently inactive – project initiated, but has not/will not be completed.
Completed – no further activities with animals will be done.
IF F OR G:
______ No animals remain in FSU facilities on this AUP number.
______ Remaining animals on this AUP number have been transferred to
AUP # __________________.
3. FUNDING SOURCE Specify the funding source:___________________________.
4. PROJECT PERSONNEL
Have there been any personnel/staff changes since the last AUP was approved?
______ No
______ Yes
If yes, please complete the following sections (Additions/Deletions). For
additions, please state training/experience.
FSU IACUC Annual Review Form
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Additions:
Name/Role/Responsibility for Project/Training/Effective Date
________________________________________________________________________
Deletions:
Name
Effective Date
________________________________________________________________________
5. PROBLEMS/ADVERSE EVENTS (THIS QUESTION MUST BE
ANSWERED)
If the status of this project is 2 A (Active – project ongoing) or 2B (Currently inactive project was initiated, but is presently inactive), describe any unanticipated adverse events,
morbidity or mortality, the cause(s), if known, and how these problems were resolved. If
NONE this should be indicated.
6. ALTERNATIVES TO POTENTIALLY PAINFUL PROCEDURES
Procedures that cause the least amount of pain or distress to animals should be considered
and used whenever possible. If this project includes procedures that could reasonably be
expected to cause more than slight or momentary pain or distress, have alternatives which
are potentially less painful or distressful become available since the last approval of this
AUP that could be used to achieve your specific project aims?
______ N/A
Section III.D.2. of the AUP was answered “NO”
______ YES
If yes, please describe the alternatives you have initiated with
appropriate amendment (if not submitted previously.)
______ NO
If no, describe the methods and sources you used to determine that
alternatives to these procedures are not available. These might
include computerized database searches.
FSU IACUC Annual Review Form
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7. PROPOSED CHANGES
Any proposed changes in personnel, species usage, animal procedures, anesthesia, postoperative care, or biohazard procedures must be reported in writing to the IACUC for
approval. Committee approval of the proposed changes is required prior to proceeding
with the revised animal procedures.
[Please note that if the modifications are significant, you may be required to complete a
new AUP]
______
No changes are planned and the project will continue as previously
approved by the IACUC
______
Minor changes are planned. Enclosed is a memo requesting the
modifications.
______
Major changes are planned. Enclosed is a revised AUP addressing
the next _________ year(s) proposed research/teaching activity.
CERTIFICATION BY THE PRINCIPAL INVESTIGATOR
By signing this document I certify that I understand the requirements of the PHS Policy
on Humane Care and Use of Laboratory Animals, applicable USDA regulations and
FSU’s policies governing the use of vertebrate animals for research, testing, teaching, or
demonstration purposes. My signature certifies I will continue to conduct the project in
full compliance with the aforementioned requirements. My signature further certifies that
the proposed work does not unnecessarily duplicate previous experiments.
________________________________
Signature – Principal Investigator
____________________
Date