University of Connecticut
IACUC-2: Use of Invertebrates, Biological Materials or Animal
Observation in Teaching or Research
Institutional Animal Care and Use Committee, Office of Research Compliance
Whetten Graduate Center, Rm #214, 438 Whitney Road Ext., Unit 1246 Storrs, CT 06269-1246 860-486-8802
Office Use Only
IACUC Protocol #____________
Approval Date: _____________
Expiration Date: _____________
Species: __________________
Guide exceptions: Y__N__
Hazards: Y__ N__
Hazards: Y___ N___
Instructions: This form is to be used to describe to the Institutional Animal Care and Use
Committee (IACUC) your research or teaching activities involving animals in the following
instances:



The proposed activities involve the use of live invertebrate animals that will cohabit with vertebrate animals (Complete Sections I, II,
III & VI)
The proposed activities only require the use of biological materials (blood, tissues etc.) obtained from animals NOT purchased,
housed or cared for at the University of Connecticut (Complete Sections I, II, IV& VI)
The proposed activities involve the observation, filming or other documentation of animal activities with no interference on the part
of the researcher, either directly or through environmental manipulation (Complete Sections I, II, V & VI)
Please provide the following information. Submit the completed form to
Arlene.jacobsen@uconn.edu
Section I: PI (Principal Investigator) and Laboratory Information
Principal Investigator (PI)
Department:
E-mail:
Unit #:
Phone #:
Emergency contact information (please provide cell phone#):
Section II: General Project Information
A.
B.
Project title
►
Project Summary: Please describe how animals will contribute to the proposed exempt activities and why you believe your
activities should be exempt from further review (e.g. using invertebrates, obtaining biological specimens from animals not
owned or housed at UCONN, naturalistic observations, etc.).
►
Section III: Invertebrate animals: Will the proposed activities involve the use of live invertebrate animals that will cohabit with vertebrate
animals?
No (Proceed to section IV)
Yes (Complete the following):
A.
What invertebrate animals will be used?
►
B.
Where will the animals be housed?
►
Appendix A | 1
C.
What, if any, hazards are associated with the use of the animals identified above?
►
Section IV: Biological Materials: Will the proposed activities involve the use of biological materials (i.e. carcasses, blood, tissues, bodily fluids)
obtained from animals?
No (Proceed to section V)
Yes (Complete the following):
A.
Describe the nature of the biological materials to be used
►
B.
Describe where this material will come from (e.g. commercial service, another investigator, etc.)
►
C.
Explain how you propose to use this material
►
D.
Hazards associated with the biological material (radioisotopes, biohazards, chemical hazards, etc.)
►
1.
What, if any, biosafety procedures are required for the safe handling/disposal of the hazards identified above?
►
Section V: Animal Observation: Will the proposed activities involve the observation of animals?
No (Proceed to section VI)
Yes (Complete the following):
A.
Provide the location of the observation activities
►
B.
What documentation/data will be obtained (i.e. photos, video, demographic data, etc.)
►
C.
Will the proposed activities have any effect on the natural behaviors of animals or on their environment?
►
Section VI:
Signatures
Principal Investigator:
Name:
Signature:
Date:
Student (if student project):
Name:
Signature:
Date:
Department Head :
I certify that I have reviewed the content of this protocol.
Name:
Signature:
Appendix A | 2
Date:
For IACUC Office Use Only
IACUC Recommendations:
Exempt
The described activities are not exempt and must be reviewed further using the
standard protocol review process
IACUC Chair Signature:
Date:
Appendix A | 3