Animal Ethics Committee
AMENDMENT TO APPROVED ANIMAL ETHICS PROJECT – MINOR
[Do not print this form. Fill it in with MS-Word, approvers to enter name with comments.]
OFFICE USE ONLY (November 2015)
[ ] Approved
[ ] A Training Record form must be completed when it is identified that staff require further training as a
result of the Approval of a minor amendment. The Training Record form is available at
http://www.research.uwa.edu.au/staff/forms/animals
SIGNATURE:
DATE:
It is a requirement of the Animal Ethics Committee (AEC) that the Chief Investigator consult with one of the
following people before lodging an Amendment form for consideration by the AEC.
 Animal Welfare Officer
 Animal Welfare Veterinary Advisors
6488 7882
6488 4549 / 4700
awo@uwa.edu.au
vets-research@uwa.edu.au
Note: a minor amendment is project modification which does not increase the pain and distress
experienced by animals.
PLEASE INDICATE ALL CATEGORIES WHICH ARE APPLICABLE TO THIS MINOR AMENDMENT ()
Extension of Approval Period ≤ 3 months
Section 1
Subsequent requests must be submitted as a Major Amendment
Minor Increase in Animal Numbers (an addition of 3 animals OR <10%, clarify with
AEO/AWO if necessary) (signature ACS Technician in Charge required)
Change in Sex of Animal (signature ACS Technician in Charge required)
Section 4
Change of Strain within a Species *
Section 4
Change to Housing / Location etc (signature ACS Technician in Charge required)
Section 5
Change to Method of Transport (signature ACS Technician in Charge required)
Section 5
Addressing the three R’s is COMPULSORY
Section 6
Minor change to collection times
Section 7
Minor change to non-surgical procedure e.g. less frequent or less Invasive
Section 7
Change to Methods of Euthanasia
Section 8
Minor change to monitoring regime and/or forms
Section 8
Declaration – For All Investigator/s COMPULSORY
Section 9
Section 5
1. PROTOCOL DETAILS
Approval No: RA/3/
Protocol Title:
Chief Investigator:
School:
AEC approval start date:
(dd/mm/yyyy)
Proposed Amendment start date:
(dd/mm/yyyy)
Approved Expiry Date:
(dd/mm/yyyy)
Extension of Approval Period - Proposed New Expiry Date:
NB: Extension granted will not exceed a maximum 5 year approval period for the life of the protocol.
2. CHIEF INVESTIGATOR DETAILS
Title, first name, last name
Work mailing address /school (include UWA MBDP)
Staff number (UWA only)

Email
Phone
Mobile
3. List all changes that apply to this amendment.
JUSTIFICATION – Detail each change proposed and provide a justification /explanation for the
changes compared to the original application - How will the changes link with the original
approved application. Must be written in lay language
4. ANIMAL SUMMARY - CURRENTLY APPROVED COMPULSORY SECTION
**Animal Species Categories available at: http://www.research.uwa.edu.au/staff/forms/animals
Common Species Scientific Background
species Category
name
Strain
name
**
Mouse
01
Mus musculus
C57BL/6J
Full Research
Nomenclature
Also Known As
Total
(AKA)
Numbers
C57BL/6J MexTAg
MexTAg
6
Total number of all animals =
ANIMAL SUMMARY – REVISED TOTALS FOR APPROVAL COMPULSORY SECTION
(Total Number of Animals in the whole project)
Common Species Scientific Background
Full Research
Also Known As
Total
species Category
name
Strain
Nomenclature
(AKA)
Numbers
name
**
Mouse
01
Mus musculus
C57BL/6J
C57BL/6J MexTAg
MexTAg
6
Revised total number of all animals (over the life of the project) =
Source Vendors:
Yes [ ]
OGTR / Department of Agriculture, Fisheries & Forestry (DAFF) Biosecurity
restrictions
No [ ]
*CHANGE OF STRAIN WITHIN A SPECIES - For GM animals, must include Phenotype Report that poses no
additional animal welfare concerns (R171/15)
Phenotype report is attached [ ]
Animal Care Services (ACS) Technician-In-Charge - COMPULSORY SECTION
[Technician to comment and state approval and any conditions in this space – TIC: please include your name and date]
For sections with no change please indicate as NO CHANGE (except compulsory sections)
5. HOUSING AND LOCATION OF ANIMALS (SIGNATURES REQUIRED)
UWA Animal Care Services (ACS)
 OTHER UWA Facilities / locations:
A Block, QEII Medical Centre
Harry Perkins Institute, QEII (QQ)
M Block, QEII Medical Centre
Z Block - Fremantle Hospital
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
updated 11 December 2015
Biomedical Research Facility, Shenton Park
Biological Resources Support Facility
Shenton Park
Sheep Research Facility (SRF), Shenton Park
Pre-Clinical Facility (PCF), Crawley Campus
Large Animal Facility (LAF), Crawley Campus
Other - Please provide details
Facility room
number/zone
Aquatic Research Facility (School of Animal Biology)
Aquaculture and Native Fish Breeding
(Shenton Park)
Ridgefield Farm (Pingelly)
Harry Waring Marsupial Reserve (Wattleup)
Ernest Hodgkin Marine Laboratory (Watermans)
Director UWA (ACS) Facilities /
Species
Age or
Curator
of other site or facilities
Gender
Reproductive
initial
(and/or strain if
Signature and Date
status
weight
applicable)
[DACS / Curator: Please print:
Name, Approval and Date]
A. WHAT IS THE MAXIMUM LENGTH OF HOLDING IN WEEKS?
B. WHAT ADDITIONAL ENRICHMENT WILL BE PROVIDED FOR ANIMALS WHICH WILL BE HELD LONGER THAN 3
MONTHS?
C. PLEASE DETAIL THE METHOD OF TRANSPORT AND ANY ANIMAL WELFARE IMPLICATIONS:
Transport and acquisition permits/approvals are attached [ ]
6. ADDRESSING THE THREE R’S – COMPULSORY SECTION
How will this amendment affect the three R’s of Reduction, Refinement & Replacement?
How are the 3R’s addressed in this amendment?
A. REPLACEMENT - describe the alternatives to animal use that you have considered and/or adopted.
B. REDUCTION - describe the ways this amendment will minimise the use of animals.
C. REFINEMENT – describe the ways this amendment will minimise the adverse impact of the intended
project on animals.
7. NON SURGICAL PROCEDURES – GIVE DETAILS OF CHANGE
Full description of changes to non-surgical procedures as listed BELOW.
If substances are being administered to animals please include details of route, volumes, frequency, intervals and
duration and COMPLETE SECTION 8 (ANIMAL WELL-BEING)
Summary description of change to all non-surgical procedures.
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updated 11 December 2015
Type of non-surgical
Expected impacts of the Expected frequency of
procedure to be carried out procedure
adverse impacts
e.g. gavage
Minor discomfort
rarely substance enters airway
or oesophagus is damaged
Some discomfort on each
occasion. Substance in airway or
oesophageal damage in less than
1 in 1000 administrations.
Refinement taken to
minimise impacts
Good handling to minimise
discomfort and observation
after dosing with humane
killing of any animal showing
signs of mis-dosing or
damage.
Who will perform these new procedures?
Provide details of their specific training and competency in these procedures
8. ANIMAL WELL-BEING - Give details
A. Post-procedural pain and distress – How will pain and distress be monitored, scored and treated
B. Monitoring schedule – Provide a Post-Procedural Monitoring Sheet and /or Long Term Monitoring Sheet
C. Criteria for Euthanasia - How will animals be assessed for euthanasia
Method of Euthanasia – previous approved method:
requesting new method and justification for this change:
D. What % of animals do you expect to die or require intervention euthanasia during this
project?
Please explain likely reasons for the anticipated loss rate.
Potential cause of
death or euthanasia
Impact on welfare
Steps taken to minimise impact
e.g. vessel rupture
irreversible haemorrhage
haemorrhage apparent to surgeon, animal <1%
would be euthanased whilst still under
general anaesthesia
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Percentage of
animals affected
updated 11 December 2015
9. DECLARATION
As chief investigator, I declare that I
(i)
have read and agree to abide by the conditions and constraints of the Australian Code for the Care
and Use of Animals for Scientific Purposes (8th edition, 2013);
(ii)
acknowledge that the information contained in this form is a true and accurate record;
(iii) understand any non-compliance with ‘The Code’ must be reported immediately to the AEC and may
result in the withdrawal of project approval and possible disciplinary action;
(iv) understand that in keeping with AEC and ACVS policy, all animals are to be monitored as detailed in
the application. The Animal Welfare Officer (AWO) has the authority to euthanase distressed
animals. Every attempt will be made to inform the (CI) before any action is taken;
(v)
understand it is the responsibility of the CI to maintain animal record and to supply annually, an
Annual Report on animal usage to the AEC;
(vi) understand that in the event of an animal death, or an unplanned euthanasia, we will immediately
report the death to the AWO, complete a Notification of UNEXPECTED DEATH FORM and email to
AWO within 48 hours, and arrange for an autopsy to be carried out and the results of the autopsy
report to be sent to the AWO;
(vii) will ensure that the qualifications and/or experience of all listed personnel are appropriate to the
procedures to be performed;
(viii) certify that the resources in the School or department, including housing and personnel, are
appropriate for the welfare of the animals and the satisfactory completion of the project.
(ix) have obtained agreement from all personnel listed on this application that they agree to all of the
above statements of declaration.
☐
I agree to all of the above.
☐
I have obtained agreement from all other research personnel on this project that they also
agree to this application and any conditions set on its approval.
(Keep the emails or other evidence of this).
CHIEF INVESTIGATOR
[Type name and Date]
Please email this form to: awo@uwa.edu.au
UWA policy deems this document as signed if you type your name and send it attached to an
email. Please send the documents as MS-Word or pdf, NOT Scanned.
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updated 11 December 2015