Protocol#:
Approval Date:
Expiration Date:
NON-INVASIVE FIELD STUDY: FORM B
This form is for field studies that do not harm or materially alter the behavior of the animals under
study (i.e., observational in nature and do not involve trapping/capture, physical/chemical restraint,
and/or invasive procedures). This is a shortened version of the long protocol form and may be used
as the stand-alone protocol only in the case of observational studies.
ADMINISTRATIVE INFORMATION SHEET
1. Principal
investigator:
Phone #:
Email:
Fax:
Emergency Contact #:
Department/Campus address (Mail Code):
2. Animal will be used for:
Instruction
If used for instruction, course #
and semester
Research
.
If used for research:
Is this project federally funded?
YES
NO
Sponsoring agency(ies):
UH Proposal No.(s), if any:
If proposal(s), list titles(s) and submission deadline(s):

PROJECT TITLE:
3. Provide information for each person who will be working with the animals. You may CUT-ANDPASTE this information. Indicate the date(s) of the most recent training session for each individual.
Titles should describe the project assignment and not necessarily academic appointment.
DOR.ORPCC.A.0IA - IACUC Non-Invasive Field Study Form B
Form updated March 2015
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Field Study
Training
Date
Title
Name
(Indicate PI and
Secondary Contact)
UH Email Address
Phone #
OHSP
Approval
Date
4. Investigator's Lay Summary of the Project. THIS IS RESTRICTED TO 100-150 WORDS and should reflect
the purpose and benefit of the proposed field study. THIS SUMMARY SHOULD BE WRITTEN IN LAY
LANGUAGE AND BE APPROPRIATE FOR RELEASE TO THE NEWS MEDIA.

5. Assure that the “Release of Liability” forms are filled out for every participant in the field study.
6. Provide a summary of the Field Study Training that is to be given to the participants. Appropriate
field study guidelines should be consulted in the development of this training as described in the
IACUC Policy: Field Studies. Training must require an ACO Occupational Health and Safety Program
(ACO OHSP) training specific to the field study proposed.
7. Fill out the following chart for all animals to be observed and locations that they will be observed:
Mark applicable
species status
(C=Concern, T=Threatened,
E=Endangered)
Common name, Genus and Species:
;
;
;
;
;
;
;
;
;
;
;
;
C
C
C
C
C
C
T
T
T
T
T
T
Locations animals
will be manipulated
1
2
3
E
E
E
E
E
E
Location 1:
Location 2:
Location 3:
List any additional locations:
For each location, submit the permission notices granted for access.
8. List the dates that the animals will be observed.
DOR.ORPCC.A.0IA - IACUC Non-Invasive Field Study Form B
Form updated March 2015
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9. Attach any federal, state or local permits that are required for this study.
10. The Environmental Health and Life Safety (EHLS) plan must be attached along with this form before
the final approval is released.
DOR.ORPCC.A.0IA - IACUC Non-Invasive Field Study Form B
Form updated March 2015
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NON-INVASIVE FIELD STUDY FORM ACKNOWLEDGEMENT
I hereby assure the IACUC that the information provided in this form is complete, accurate and that no
animals will be harassed, handled or sampled to support the scientific and/or teaching objectives outlined.
Principal Investigator:
Signature:
Name:
Date:
Environmental Health and Life Safety Approval:
Signature:
Name:
Date:
DOR.ORPCC.A.0IA - IACUC Non-Invasive Field Study Form B
Form updated March 2015
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