Bishop’s University Animal Care Committee
Animal Utilization Form for Research Projects
As required by BUACC, in accordance with CCAC guidelines, an Animal Utilization Form
MUST be filed with, and approved by, BUACC prior to undertaking any project involving
the use of vertebrate animals. The purpose of this form is to satisfy BUACC that humane
practices and proper animal care standards will be practiced.
Researchers should submit their submission form to the Research Office either by email (PDF
file including the form, duly signed and dated, and the required appendices) or by mail (hard
copy duly signed and dated).
Protocol Number (BUACC use only):___________________
1. Investigator Information
Principal Investigator:
Phone #:
Department:
Faculty Box:
E-mail:
2. Research Project Information
Title of the Project:
Type of Research:
__Basic Research
__Development of products for industry
__Other, please specify:
Proposed Start Date:
Expected Date of Completion:
3. Funding Sources
a) Do you have funding for this project?
b) If yes, from which funding agency?
c) Was your project peer reviewed?
d) What is the funding period of your grant?
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4. Research Personnel
List the names and status of individuals who will participate in this investigation and
comment on the training and qualifications of those individuals who will be handling the
animals. Each individual must sign to indicate that they have read this form. Please note that
the Principal Investigator is responsible for ensuring that suitable training has occurred
before personnel actively participate in the research project.
Name
Signature
Qualifications
5. Summary of the Project (in lay terms)
a)Briefly describe the purpose of this study and its potential to advance scientific knowledge.
b) Briefly explain the objectives of the investigation.
6. Animal Data
a) Please justify the need to use live animals as opposed to computer simulations, videos, etc.
b) Describe the animals to be used.
Species:
Supplier:
Strain:
Sex:
Age/Weight:
TOTAL # OF ANIMALS:
c) Justify the use of this particular species.
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d) Justify the total number of animals used. Based on the experimental paradigm describe
how animals will be used, e.g. control group, experimental group(s).
7. Wild Animals/Field Work (if applicable)
It is the responsibility of the investigator to obtain all necessary permits for wild life studies.
Copies of these permits should be attached to this form.
a) Describe in detail how animals will be captured and the duration; method of restraint and
duration; monitoring frequency; potential for harm. Please note that traps must be inspected
on a regular basis.
b) Describe all pertinent equipment that will be used.
c) List all targeted species.
d) Describe the fate of non-targeted species.
e) Justify the need for permanent marking of animals.
f) Describe any potential environmental impact of this study.
g) Provide any other relevant information.
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8. Description of Procedures
a) Describe all procedures, manipulations and techniques which will be performed, including
surgical procedures, post-operative care, tissue samples, substance administration, behavioral
tests, restraint, dietary manipulation, environmental alterations etc. Please see the CCAC
guidelines for further information, www.CCAC.ca.
b) List all drugs (pre-anesthetic/anesthetic/analgesic agents) that will be used to minimize
pain, distress or discomfort (agent, dosage mg/kg, volume, route, frequency).
c) List all non-anesthetic agents that will be administered (agent, dosage mg/kg, volume,
route, frequency).
d) Justify withholding of anesthetic and/or analgesics for any invasive procedure.
e) Did you obtain the appropriate authorization for the use of controlled substance(s)?
f) End points:
 At what point in the experiment will sufficient data have been collected to justify
concluding the experiment and terminating the animals?
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
In any experimental procedures where there is the potential to cause distress, discomfort
or pain, the point at which animals are to be euthanized must be determined prior to
beginning the experiment. State what criteria (vocalization, unexpected body weight,
behavioral deterioration, etc.) are to be used to determine if an animal will be terminated
prior to the end of the experiment. (see CCAC guideline “Choosing an appropriate end
point…” www.CCAC.ca. )
g) Method of Euthanasia
Please note that the use of any physical method to euthanize animals without anesthesia must
be justified.
__Anesthetic overdose
__Exsanguination with anesthesia (list agent, dose and route of administration)
__Decapitation with anesthesia (list agent, dose and route of administration)
__Cervical dislocation with anesthesia (list agent, dose and route of administration)
__CO2 chamber
__Other (Please specify)
__Euthanasia without anesthesia - Please justify
h) Describe the fate of animals which will not be euthanized.
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9. Category of Invasiveness
The categories of invasiveness are adapted from the Scientists Centre for Animal Welfare,
1984. For more detailed descriptions of each category please refer to the guidelines at
www.CCAC.ca. If the level of invasiveness falls between two categories, check the more
invasive degree.
Please indicate the category of invasiveness: __A
__B __C
__D __E
A (Low or Nil): Experiments involving invertebrate animal species. Invertebrate animals
have a nervous system, and respond to noxious stimuli, and must therefore be treated
humanely
B (Low or Nil): Experiments on vertebrate animal species that are expected to produce little
or no discomfort. Manipulating animals for experimental purposes (e.g. injections, removal
from cages); injections of non-toxic substances, naturalistic observation, experiments on fully
anesthetized animals, and standard methods of anesthesia fall within this category.
C (Low to Moderate): Experiments that involve some discomfort (short lasting) to vertebrate
animal species. Implantation of cannulae, or catheters, short periods of restraint as part of the
experimental protocol; food and water deprivation for short periods of time, protocols using
escape from noxious stimuli, social isolation or crowding, minor surgical procedures under
anesthesia, among others.
D (Moderate to High): Experiments that involve significant but unavoidable distress or
discomfort to vertebrate animals. Major surgical procedures under anesthesia with postsurgical pain or discomfort or functional deficit, application of inescapable noxious stimuli,
maternal deprivation, prolonged periods of restraint, induction of aggressive behavior,
procedures that alter perceptual or motor functioning of an animal. Category D experiments
present an explicit responsibility on the part of the investigator to explore alternative designs
to ensure that animal distress is minimized.
E (High or Severe Pain): Experiments that involve inflicting severe pain on conscious
vertebrate animals. Procedures involving severe pain or severe deprivation, burn or severe
trauma infliction on anesthetized animals that are allowed to recover consciousness,
inescapable stress; painful shock, use of muscle relaxants to induce surgical restraint without
use of anesthesia among others. Category E experiments are considered to be highly
questionable or unacceptable, regardless of the significance of the result.
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10. Use of Hazardous Materials
The principal investigator must obtain all permits related to the use of hazardous materials or
radiation and must attach a copy of these permits to this form.
a) ___ No hazardous materials or radiation will be used.
b) The following materials will be used:
Toxic Chemicals __
Radioisotopes __
Infectious agents __
Other __
Carcinogens __
c) Complete the following table for each agent used
Substance Name
Dose (mg/kg)
Volume/administration
Frequency of administration
Duration of administration
d) Describe any potential health hazards to humans and animals.
e) Describe measures implemented to reduce the risk to humans, animals, and the
environment by exposure to or resulting from these biohazards.
11. Investigator’s Declaration: The information contained in this application is complete
and accurate. Animal use will conform to the practice and principles outlined in the “Guide
to the Care and Use of Experimental Animals”, Volumes 1 and 2, prepared by the CCAC,
BU Terms of Reference, BU Standard Operating Procedures, and other relevant guides. No
modification of the protocols described in this application will be made without the prior
permission of the Bishop’s University Animal Care Committee. I understand that approval
of this application is valid for one year, and must be renewed if experimentation continues
beyond that point.
Signature of Principle Investigator:________________________________________
Date:_________________________