IDAHO STATE UNIVERSITY INSTITUTIONAL ANIMAL
CARE AND USE COMMITTEE ANIMAL-USE
PROTOCOL FORM v3
Number
GENERAL INFORMATION
Protocol Title:
Principal Investigator:
Department:
Phone:
E-mail:
Co-Investigator:
Department:
Phone:
E-mail:
Is this protocol being reviewed by another institution or agency’s IACUC? Yes
No
Protocol is
Research
Appendix A (may apply: C, D, E)
(Note: Appendix A is MANDATORY)
Field
Appendix A & B
Teaching
Appendix A & C
Source of Funding:
(award #)
Project Period Start From:
To:
(IACUC protocol approval is for three years.)
Assurances
1.
2.
3.
4.
5.
6.
7.
I agree to abide by PHS Policy, USDA Regulations, National Research Guide for the Care and Use of Laboratory Animals,
AAALAC, and all federal regulations and policies of Idaho State University governing the care and use of animals in research,
teaching or testing.
I will insure that all laboratory personnel having direct live animal contact will be appropriately trained for all animal procedures
used on the project and complete required training listed in personnel statement.
I certify that all experiments and surgeries involving live animals will be performed under my supervision or that of another
qualified professional listed on this protocol.
I will maintain animal medical records (procedure sheets) for review by the IACUC, animal facility staff and Attending
Veterinarian.
I will request prior approval from the IACUC pertaining to any changes in this protocol.
I certify that the information provided within this protocol is accurate to the best of my knowledge. I also understand that
should I use the project described in this protocol as a basis for a proposal for funding (either intramural or extramural) it is my
responsibility to insure that the description of animal use in such funding proposal is identical in principle to that contained in
this protocol.
I certify that I have read the above listed protocol and am qualified to perform the procedures described herein; I further agree
to abide by the protocol and to notify the committee of any proposed deviations from it.
Signature:
Date:
For committee Use Only
Occupational Health and Safety Specialist
Risk Assessment
_Low
Medium
Approve
Disapprove
High
Recommendations:
Signature
Date
With due regard for the regulations and relevant University policy,
the Institutional Animal Care and Use Committee of Idaho State University
has reviewed and approved the care and use of vertebrate animals in this project.
Chair, ISU Institutional Animal Care and Use Committee
Approval Date Stamp
Please answer all questions or check N/A where applicable
I. SIGNIFICANCE, RATIONALE AND ASSURANCE
1. Describe the specific goals of this project clearly and concisely. Use language understandable to
nonscientists and avoid acronyms.
a. What is the purpose of the study?
b. What significance, rationale and potential benefits might be derived from the study?
2. Incorporate in your proposal the alternatives to animal use: reduction, refinement and
replacement.(Simply stating, “no alternatives are available” is unacceptable).
3. Provide the following details for a literature search used to explore for alternatives to animal use and
alternatives to painful procedures. Alternatives should be considered for any aspect of the protocol that may
cause more than momentary or slight pain or distress. All protocols (research, field, and teaching) must
conduct this search.
a) Databases searched (at least two):
Medline
Library of Congress
Animal Welfare Information Center
National Agriculture Library
ALTWEB
Web of Science
Other (please specify)
b) List key words (minimum of five) used in the
search: Date of search:
Dates searched:
Please give one or two sentences on the result of your search.
II. ANIMAL USE
Species
Common Name
Total
Numbers
~Year 1
~Year 2
Sex
Age/Weight
Source of Animals
~Year 3
1. Briefly describe the biological characteristics of the species that justifies its use in the protocol. Please do not
list methods here. Cost should not be the primary justification.
2. Justify the number of animals to be used.
3. If you use DEA-controlled substances, please list their locations (building and room number). The
IACUC is required to inspect these semi-annually.
III. METHODS AND PROCEDURES
1. Type of procedure: See below
Research Procedures:
Type B: Experiments on vertebrate species that are expected to produce little or no discomfort.
Type C: Experiments that involve some minor stress or pain (short-duration pain) to vertebrate
species. Type D: Experiments that involve significant but unavoidable stress or pain to vertebrate
species.
Type E: Procedures that involve inflicting severe pain near, at, or above the pain tolerance threshold
of conscious animals with no anesthesia.
2. Explain your selection. U.S. Government Principle IV: “Unless the contrary is established, investigators
should consider that procedures that cause pain or distress in human beings may cause pain or distress in
other animals.”
Research Protocol-Main-Form-v3 (Word/docx) updated 8/21/15
Procedure:
Provide a detailed procedure, in lay terms, understandable by a nonscientist, that effectively describes what
happens to the animals from acquisition to euthanasia. If applicable, please describe surgical approach, suture,
and procedures. Flow charts, diagrams or tables are strongly recommended for complicated experimental design.
Where will procedures be performed? (Provide building and room number.)
Sterile surgery suite Biology102
Non-sterile surgery area Pharmacy B20
Other
ANESTHESIA (IF APPLICABLE)
Drug
Route of Delivery
N/A
Dose
(eg., mg/kg)
Schedule
(e.g., times/day)
Length of Anesthesia
i. Who is responsible for maintaining anesthesia? (Animal must be under direct supervision until protective
reflexes have returned)
ii. Methods used to monitor anesthesia:
iii. If inhalation anesthetics are used, describe the system for scavenging waste anesthetic gas.
METHODS TO ALLEVIATE PAIN AND/OR DISTRESS. List analgesics, tranquilizers, ataraxic or
behavioral modifications. If your procedure is likely to produce pain or distress, the use of analgesics, tranquilizers (or
other methods to alleviate distress), is expected. OR you must provide a narrative to justify why no drugs or methods are
used to alleviate pain or distress.
None:
(If none please justify):
Drug/Class
Dose (e.g., mg/kg)
Route of Delivery
RESTRAINT
1. Methods or devices used:
2. Duration of restraint is momentary or more than momentary. Explain/Describe methods used to alleviate
stress due to more than momentary restraint.
METHODS OF EUTHANASA/FINAL DISPOSITION All methods of euthanasia must follow the most
current AVMA Guidelines on Euthanasia.
1. Methods are:
a.
Acceptable
b.
Acceptable with Conditions
i. Justification (describe how conditions are met):
Method
Drug/Class
Dose (e.g., mg/kg)
Research Protocol-Main-Form-v3 (Word/docx) updated 8/21/15
Route of Delivery
2. Describe methods to ensure the animal will not revive:
3.
Humane Endpoint(s). (Is the point at which pain or distress in an experimental animal is prevented,
terminated, or relieved.) Provide plan to determine when an animal will be euthanized and removed from the
study.
Experimental Endpoint(s) (Occurs when the scientific aims and objectives have been reached.) Because
of the potential for additional pain and distress justification is required.
PAIN AND DISTRESS PRODUCING PROCEDURES - * This section to be filled out if the protocol is a type C,
D, or E procedure.
PROCEDURES
Procedure to be applied to animals.
1. Describe pre-operative or preliminary procedures This includes procedures employed to ensure aseptic
technique is maintained, ensure health of animals, surgical preps, drugs used, prophylactic measures,
instruments.
2. Describe any potential post-operative or post procedure complications and methods to identify, assess, and
manage these problems.
3. List all personnel who will handle the animals and state their prospective duties. (To be filled out by the
principle investigator.)
Where will surgical procedures be performed? (Provide building and room number.)
1. Sterile surgery suite
2. Non-sterile surgery area
3. Other
5. Describe long-term care of any chronic survival procedures:
FIELD STUDY
N/A
APPENDIX B ATTACHED
TEACHING
N/A
APPENDIX C ATTACHED
ANIMAL HUSBANDRY
N/A
APPENDIX D ATTACHED
BREEDING
N/A
APPENDIX E ATTACHED
Research Protocol-Main-Form-v3 (Word/docx) updated 8/21/15