St Vincent’s Hospital
(Melbourne) Limited
ABN 22 052 110 755
41 Victoria Parade Fitzroy VIC 3065
PO Box 2900 Fitzroy VIC 3065
Telephone 03 9288 2211
Facsimile 03 9288 3399
www.svhm.org.au
St Vincent’s Hospital (Melbourne)
Animal Ethics Committee (AEC)
APPLICATION TO GENERATE AND BREED
A NEW MOUSE LINE (Single GBNML)
All research and teaching that involves the use of animals for scientific purposes must comply with ‘The
Prevention of Cruelty to Animals Act’ (1986), the associated Regulations and the NHMRC ‘Australian code for
the care and use of animals for scientific purposes’ (8th Edition 2013).
This entire application form must be written using lay language and where the use of scientific
language is unavoidable it must be supported by a suitable lay description or glossary of terms.
An answer must be provided for every question
Where possible refer to SOP’s (state SOP number and title).
List of AEC approved Clinical SOP’s can be found at:
http://www.svhm.org.au/research/governance/Pages/Operatingprocedures.aspx
This form is to be completed when requesting to generate and breed a single new mouse line.
GBNML approvals are for three years and 1000 animals
Once the phenotype is established/characterised (~5-6 generations) an application to the AEC can be
submitted to transfer the line to Specified Animal Breeding Colony Group (SABC)
The numbers of animals bred must be reported on the annual BAW Animal Use Return Part A.
Therefore, please ensure you keep accurate records of animal numbers
AEC GBNML Reference Number (assigned by AEC Secretary)
Principal Investigator
Name:
(Title, First, Surname)
Qualifications
Institution
Department
Phone
Email
GBNML Application Form (Single Line)
Version 7: January 2014
Page 1 of 3
PART A
Please provide the Institutional Biosafety Committee (IBC)
Reference Number and expiry date
Please state the AEC Reference Number for the approved
project within which this new line will be used
State the name of the new strain (e.g. H-2Kb/h TFPI)
State the full Mutation Name (Use correct nomenclature)
*For guidance refer to www.jax.org, Transgenic Res 6(5): 309-19 1997, or Genomics 45(2): 471-6 (1997)
Origin of strain
Internal
External
Name of Organisation/Department:
Name of Organisation:
PART B
Briefly describe the anticipated phenotype of the new line, including what organs or tissues
will be affected. Include any expected or anticipated abnormalities or effects on health,
welfare, breeding or lifespan.
NOTE: If the clinical status deviates from the predications made in this application, the AEC must be notified immediately.
How will the new line be created?
Cross breeding two existing strains
DNA Technique
Embryonic Stem Cell Technique
Other (please state):
State the original background strain e.g. C57BL/6
Please state where the line will be bred/housed
BRC
Are there any special husbandry or animal care requirements?
EMSU
Yes*
No
*If yes please describe;
Please indicate the fate of the animals that do not have the appropriate genotype
Euthanised (as per SOP 26 Euthanasia in mice and rats)
Other (please specify):
AEC GBNML Form (Single Line)
Version 7: January 2014
Page 2 of 3
Please indicate how the wellbeing of the animals will be monitored.
Monitored as per AEC SOP 30 Mouse Health Monitoring
Other monitoring regime
Please provide details of what signs will be monitored for and frequency.
If tissue is required for genotyping; Please select how tissue will be collected
Biopsy
Tail tip
Toe clip
Blood
Heparin blood
Other (please specify):
Please describe the locus of the modified gene/s for genotyping purposes.
Include all mutations as loci 1, loci 2, loci 3 etc.
Locus Number
Mutation Type
Gene Name
Chromosome
Animal Facility Manager Declaration
I hereby confirm we can facilitate the above application to Generate and Breed a New Mouse Line
and adequate housing is available for these animals.
NAME
SIGNATURE
DATE
Principal Investigator Declaration
I hereby confirm that the information provided in this form is true and correct and that all work will
be carried out and managed as per the Australian code for the care and use of animals for scientific
purposes 8th Edition 2013.
NAME
SIGNATURE
AEC GBNML Form (Single Line)
Version 7: January 2014
DATE
Page 3 of 3