Continuing Review Request
Request for CONTINUING REVIEW by the IACUC
PROTOCOL NUMBER:
Contact Information:
Principal Investigator:
Department:
Office Phone:
Lab Phone:
Home Phone:
Fax #:
E-mail:
Project Information:
Project Title:
Approval Date:
Species:
Expiration Date:
Hazards:
1. Are you still actively engaged in this protocol? ( )yes ( ) no. If NO, indicate the date of the
termination:_____________. Sign and return the form.
IF YOUR ANSWER IS YES, PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS:
Instructions for completion appear on the reverse.
2. Does the protocol involve hazards? ( ) yes
( ) no
3. Have you encountered any difficulties (such as colony-wide diseases or complications with surgical
procedures) with the animals involved in this protocol? ( ) yes ( ) no. If yes describe those problems
and their resolutions on an attached sheet.
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Continuing Review Request
4. Do you intend to make any significant changes which deviate from the protocol you originally
submitted? ( ) yes ( ) no. If yes, please attach a detailed description of the changes. Significant
changes include (but is not limited to):
(a) changes in the objectives of the study
(b) switching from non-survival to survival surgery
(c) changes in the degree of invasiveness of a procedure or discomfort to an animal
(d) change in the species or the approximate number of animals used
(e) change in the personnel involved in animal procedures
(f) change in the anesthetic agent(s) or in the use or withholding of analgesics
(g) change in the methods of euthanasia
(h) change in the duration, frequency or number of procedures performed on an animal.
5. List the names of all personnel involved in the protocol. Include the University title, experience, or
training in the planned procedures.
6. If the proposed procedures, might cause more than momentary pain or distress, (It is the USDA’s
position that terminal surgery is a potentially painful procedure with the pain alleviated by anesthesia
[depending on the plane of anesthesia] and that it is considered a painful procedure which is alleviated by
drugs.) list the sources that were used to determine that non-painful alternatives are not available. Check
all that apply.
[ ] Literature search was conducted.
a.
List data base consulted (e.g. Index Medicus).
b.
Date of search:
c.
Years covered by search:
d.
Key words or search strategies used:
You may be requested to provide results.
[
[
[
[
] The Animal Welfare Information Center of the National Agricultural Library was consulted/
] Recognized experts in the field were consulted (give name and affiliation).
] Other (explain):
] Not Applicable (a protocol using surgery may not choose this option)
7. Make any corrections to your personal contract information which appears at the top of page.
______________________________________________
Signature of Principal Investigator
Return to:
___________________
Date
P. Andrew Leynes, Chair of the IACUC
Psychology Department
The College of New Jersey
iacuc@tcnj.edu
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