Protocol Number:
(office use only)
Date Originally Approved:
(office use only)
Expiry Date:
(office use only)
BRANDON UNIVERSITY
RESEARCH/TEACHING ANIMAL USE PROTOCOL
AMENDMENT
Applicants must complete all sections and email the completed application to buacc@brandonu.ca. Applicants must also complete
a “Declaration” and send the original to the Research Office (Room 113 Clark Hall) in advance of the meeting.
NOTE: A renewal form may be used for projects which received approval and no change to the original protocol has developed.
This form can be submitted no more than THREE times for a given project. After three submissions, a new protocol must be
completed. Questions about using the form should be directed to Shannon Downey, BUACC Coordinator & Executive Assistant to
the Vice-President (Academic & Provost) at ext. 712 or downeys@brandonu.ca.
I. PROJECT/COURSE INFORMATION & PERSONNEL
1.
Project Title and/or Course Number and Title:
2.
Highlight the changes from the original approved protocol.
3.
This amendment includes the addition of new species or strains.
4.
Personnel:
Yes
No
Principal Investigator/Instructor:
Name
Department
Phone
Email Address
II. CCAC CATEGORIZATION
5.
This Study is:
PLEASE CHOOSE ONE
6.
Maximum CCAC Category of Invasiveness:
PLEASE CHOOSE ONE
B:
C:
D:
E:
7.
studies or experiments causing little or no discomfort or distress
studies or experiments involving minor stress or minor short duration
studies or experiments involving moderate to severe distress or discomfort
procedures that involve sever pain at or above the pain toleration threshold of unanaesthetized, conscious
animals (category E procedures are normally not acceptable)
CCAC Purpose of Animal Use (PAU):
1:
2:
3:
4:
5:
CATEGORY THAT BEST FITS THE PROJECT
studies of a fundamental nature in sciences relating to essential structure and function (e.g. Biology,
Psychology, Biochemistry, Pharmacology, Physiology, etc.)
studies for medical purposes, including veterinary medicine, that relate to human or animal disease or
disorders
studies for regulatory testing of products for the protection of humans, animals, or the environment
studies for the development of products or appliances for human or veterinary medicine
education and training of individuals in post-secondary institutions or facilities
2
III. CHANGE OF ANIMAL NUMBERS OR TYPE(S)
8.
Change in Animal Numbers:
Species or Strains Currently
Approved
Number Requested
Number Approved
Total
Max. Any Time
9.
Justification for the Change (e.g. statistical requirements, required product yield, etc.)
10.
Change or Addition of Species or Strains:
Species or Strains
Current Approved
11.
Number
Approved
Species/Strains to
be REMOVED
from Protocol
Species/Strains to
be ADDED to
Protocol
Number Requested
Total
Max. Any Time
Justification for both the changes to species or strains being used, and for the numbers of animals of each new species
or strain required.
NOTE: If a transgenic, mutant or “knockout” strain is to be used, you must complete Schedule 12. If Schedule 12 was
submitted with the original protocol, please specify below any amendments to it that these changes necessitate.
IV. CHANGES TO DRUGS OR OTHER AGENDA BEING GIVEN TO ANIMALS
12.
Anaesthetic/Analgesic Drugs – Please complete the following table.
Drugs Now
Approved
Reason for the changes:
Dose/Route
To be Replaced
By
Dose/Route
ADDITIONAL
Drugs Required
Dose/Route
3
13.
Other Drugs/Compounds – Please complete the following table.
Drugs Now
Approved
Dose/Route
To be Replaced
By
Dose/Route
ADDITIONAL
Drugs Required
Dose/Route
Reasons for the changes:
Please specify any expected side effects which may result from each of these changes.
NOTE: If any of the changes above involve hazardous drugs or agents, Schedule 6 must be completed and submitted. If
Schedule 6 was submitted with the original protocol, please specify below any amendments to it that these changes
necessitate.
V. MINOR PROCEDURAL CHANGES
NOTE: If major procedural changes are to be made to this project, a new protocol must be submitted. Consult the Chair of the
Animal Care Committee for help in deciding whether your changes are minor or major.
14.
Please specify below any minor procedural changes and the reasons for making them.
VI. CHANGES IN FUNDING/PROJECT TITLE
15.
List any changes in funding source(s) for this project.
16.
If any of the above changes have made a change in the title of this project appropriate, please give the revised project.