Protocol for Approval of Activities Involving the Use of Laboratory
Animals
Office of Research Compliance
309A University Hall
Bowling Green State University
Bowling Green, OH 43403
419-372-7716
Read but Do Not Submit the First Page of this Application
The attached protocol form is to be used when requesting review by the Bowling Green State
University Institutional Animal Care and Use Committee (IACUC) for approval of
research/teaching/display activities involving vertebrate animals. This information is required by
NIH under Section 2F, Vertebrate Animals, and by the USDA effective October 30, 1989, per
A.P.H.I.S., Final Rules Pertaining to the Animal Welfare Act. Approved protocols will be periodically
monitored to ensure compliance.
Please be thorough and explicit. Failure to respond to all the requested items, to submit all
appropriate documents, or to obtain all required signatures will result in a delay in
reviewing your application.
The information contained in this protocol form may become publicly available either through the
open records act or through open meetings.
Each type of activity requires a separate protocol and response. Although more than one species
may be included in a single protocol, each species will require its own independent narrative.
Once this form is completed it:
 Should be previewed by the University Animal Facilities Director, Jenifer Baranski
(jbarans@bgsu.edu).
 Must be reviewed by the Attending Veterinarian, Dr. Susan Orosz
(drsusanorosz@aol.com) prior to IACUC review. Notification of approval by the Attending
Veterinarian must be communicated to the Office of Research Compliance prior to the
meeting at which the protocol will be reviewed.
 If this project includes any activities involving the use of recombinant DNA it must also be
submitted to Scott Rogers (srogers@bgsu.edu), BGSU’s Institutional Bio-Safety
Committee (IBC) Chair. Approval by the Biosafety Committee must be communicated to
the ORC prior to the meeting in which the protocol will be reviewed.
Remember to:
 Take the appropriate online training. Instructions can be found at the “Researcher Training”
link at: http://www.bgsu.edu/offices/orc/iacuc.
 For in-person euthanasia training, contact the UAF Director (jbarans@bgsu.edu; 3728753).
 Sign the protocol before submitting.
 Deliver the original signed hard copy and any supporting documents (literature search
specifics, grant proposals, etc.) to the IACUC c/o Office of Research Compliance, 309A
University Hall.
 Email the electronic copy of the protocol and supporting document to the IACUC c/o
hsrb@bgsu.edu.
Both the hard copy and the electronic versions must be sent to the ORC by the submission
deadline, which can be found at the IACUC's Meeting Calendar web page.
Institutional Animal Care and Use Committee (as of September, 2013)
http://www.bgsu.edu/offices/orc/iacuc
Bowling Green State University Animal
Research & Teaching Laboratory Protocol
as of September, 2013
1. Title:
2. Principal Investigator:
3. Protocol participants who will be working with live animals [AWA 2.32]
**Note: if online training has not yet been completed, see the IACUC website for training instructions
(http://www.bgsu.edu/offices/orc/iacuc).
Name
Investigator
Protocol #
University /
Dept.
Level (Faculty,
Staff, Graduate
Student, etc.)
Protocol Activities to be
Performed
For ORC
Use Only
#1-13 requires online training
completion**.
#13 Requires Euthanasia Training
(contact University Animal Facilities)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Observation
Animal Handling
Animal Husbandry
Behavioral Testing
Trapping / Tagging
Disease Treatment
Injections / Fluid Withdrawals
Tissue Sampling
Anesthesia
Perfusion
Non-Survival Surgery
Survival Surgery
Euthanasia
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Observation
Animal Handling
Animal Husbandry
Behavioral Testing
Trapping / Tagging
Disease Treatment
Injections / Fluid Withdrawals
Tissue Sampling
Anesthesia
Perfusion
Non-Survival Surgery
Survival Surgery
Euthanasia
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Observation
Animal Handling
Animal Husbandry
Behavioral Testing
Trapping / Tagging
Disease Treatment
Injections / Fluid Withdrawals
Tissue Sampling
Anesthesia
Perfusion
Non-Survival Surgery
Survival Surgery
Euthanasia
1
Bowling Green State University Animal
Research & Teaching Laboratory Protocol
as of September, 2013
Name
Investigator
Protocol #
University /
Dept.
Level (Faculty,
Staff, Graduate
Student, etc.)
Protocol Activities to be
Performed
For ORC
Use Only
#1-13 requires online training
completion**.
#13 Requires Euthanasia Training
(contact University Animal Facilities)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Observation
Animal Handling
Animal Husbandry
Behavioral Testing
Trapping / Tagging
Disease Treatment
Injections / Fluid Withdrawals
Tissue Sampling
Anesthesia
Perfusion
Non-Survival Surgery
Survival Surgery
Euthanasia
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Observation
Animal Handling
Animal Husbandry
Behavioral Testing
Trapping / Tagging
Disease Treatment
Injections / Fluid Withdrawals
Tissue Sampling
Anesthesia
Perfusion
Non-Survival Surgery
Survival Surgery
Euthanasia
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Observation
Animal Handling
Animal Husbandry
Behavioral Testing
Trapping / Tagging
Disease Treatment
Injections / Fluid Withdrawals
Tissue Sampling
Anesthesia
Perfusion
Non-Survival Surgery
Survival Surgery
Euthanasia
2
4. Description of project
a. Please provide a brief (1-2 sentences) overall summary description of the proposed project
in the box below:
Insert Text Here
b. Please check all of the categories below that describe the type of animal use proposed in
this protocol.
Applied Research
Basic Research
Field Research
Instruction/Training/Teaching
Testing (toxicology, etc.)
Service (breeding, antibody production, etc.)
Other (Please Describe) 
c. The proposed work is part of:
an inferential study, with a specified statistical power where conclusions are to be
made about a population based on information obtained from a sample. The optimal
sample size should be determined by statistical procedures.
an exploratory/descriptive study that examines patterns and relationships of
responses; conclusions are often less definitive than in an inferential study. Sample size
often is determined by previous experience, past practice, and/or statistical rules of
thumb.
a pilot/feasibility study that is a small-scale investigation to test the feasibility of
methods and procedures in preparation for a definitive larger-scale study. The results
often can be used to aid in determining optimal sample size for future inferential studies.
an animal breeding or surveillance protocol that does not test experimental
hypotheses.
a teaching protocol that is intended to demonstrate scientific concepts.
5. Identify the animals to be used in this research [AWA 2.31(e)(1)]
Identify the species, strain and total number of animals that will be during the life of the approved
project and list the number of offspring that will be generated.
Species
Strain or common name
Total
Number
(include
offspring
separately)
Investigator
Protocol #
Office Use
Only
USDA
Category
3
6. List any special housing or special needs this protocol will require
If you are requesting that animals be single housed or other forms of enrichment withheld, you
must scientifically justify this in the text below.
Insert Text Here
7. Experimental/instructional procedures
From the list below, check all experimental or instructional procedures that will be performed on
the animals requested in this application. All procedures checked below must be explained in
question #12 (Experimental Manipulations). Check all that apply.
Level 1 training
Animal Handling
Observation only (no manipulations)
Animal Husbandry
Other (specify) 
Level 2 training
Addiction or addiction withdrawal
Behavior Modification/Operant Conditioning
Blood Collection
Capture of Wildlife
Environmental Manipulation
Gavage
Immunosuppression
Inoculation, experimental
Lavage
Obesity, experimental
Sensory Dysfunction
Tissue Sampling
Trapping/Tagging
Antibody Production
Biopsy
Breeding
Disease Treatment
Food/Fluid Restriction
Immunization, experimental
Injection/Fluid Withdrawal
Irritation, experimental
Noxious Stimulus
Restraint
Stress
Toxicity Test
Other (specify) 
Level 3 training
Amputation
Ascites Production
Cannulation
Cardiac Puncture
Euthanasia
Injury/trauma
Anesthesia
Burn
Catheterization
Dental Procedure
Implant
Irradiation
Investigator
Protocol #
4
Myocardial Infarction
Paralysis, experimentally induced
Peritoneal Lavage
Sepsis Induction
Stun
Surgical Procedure, Recovery
Tumor Growth, experimental
Organ Failure/Dysfunction, experimental
Perfusion
Radiography
Stroke
Surgical Procedure, Non-recovery
Transplantation
Other (specify) 
8. Provide a lay language (non-scientist, high school level) description of
the proposed work. . Note – if this explanation is not in LAY LANGUAGE
this WILL delay approval of this protocol.
Please provide a brief description of the work to be performed. Include the overall goal, and
how the work will benefit society, and/or human or animal health, and/or the advancement of
knowledge. Avoid technical language and most or all experimental details. These summaries
will represent your project, and be released upon request, to media reporters, animal welfare
activists, concerned citizens, etc.
Insert Text Here
9. Explain why animals must be used for this work, and provide
justification for any procedures which may cause harm or discomfort to the
animals [AWA 2.31(e)(2)].
In particular, address whether it would it be possible to conduct the work on human subjects,
tissue cultures, or by using computer simulations or inferences based on extant data.
Insert Text Here
10. Why have you chosen this particular species for the proposed work
[AWA2.31(e)(2)]?
For example, does this species have particular biological characteristics which are important for
the work? Is it that this species has been used by others in providing the groundwork?
Insert Text Here
11. Provide a description of the relevant expertise of the PI and team
members in relation to the species of animals and experimental techniques
which will be used [AWA 2.31(d)(1)(viii), 2.32], [PHS Policy IV.C.1.f]. Describe which
researcher will be performing each activity/procedure. If the proposed species and/or
experimental techniques have not been previously used by any person listed on the
protocol, explain how appropriate training will be obtained and who will provide the
training.
Investigator
Protocol #
5
Insert Text Here
12. Procedures: Provide a clear outline of the work to be performed and
justify the number of animals to be used. [AWA 2.31(e)(2),(3)]
12a. Address the following points:
 Briefly describe the rationale (goal) for each experimental group.
Tables or flow charts that detail the use of the animals can be very helpful and
are encouraged.
 Describe each aspect of the project for each group, and each
procedure to be performed in detail (e.g., observing, tagging, injecting,
surgery, training, food deprivation, special diet, transport, special housing,
special lighting, etc.).
o For behavioral tasks give a description of the apparatus, number of
trials, length of session, transport to/from session, etc.
o You can list alternate treatments or forms of substances that may need
to be used if the preferred treatment does not work.
o If you are proposing to use food or water deprivation you must include
procedures for:
 Determining the target weight for each animal,
 Recording the weight for every animal every day,
 Administering the correct amount of food (or water) each day,
 Daily recording of the amount and time of food (water) delivery,
 Posting of the weight and feeding records in an easily visible spot on
the colony room wall.
Insert Text Here
12b. Address the following points:
 Give an itemized account of all animals to be used in all aspects of
the experiment (e.g., number of animals per group/per experiment). Note
that this accounting must agree with the numbers given in Item 5 above.
 Justify the number of animals to be used in each case (e.g., describe
the population variance in relation to the planned statistical analyses,
attrition due to loss of subject/preparation, etc.).
Insert Text Here
13. Will surgery be performed? [AWA 1.1, 2.31(d), 2.33(b)]
Investigator
Protocol #
6
No - Go to item 16
Yes - Continue with item 14
14. The following questions are in regards to surgery. NOTE – A complete
description of the surgical procedure, in detail from pre-operative
procedures through to recovery including monitoring/documentation
procedures must be included in item 12 above.
14a. Location of surgery (room number):
Insert Text or "N/A" Here
14b. List the surgical and recovery team along with their qualifications.
Insert Text or "N/A" Here
14c. Detail arrangements for handling of post-operative complications,
include after-hours, weekend and holiday care.
Insert Text or "N/A" Here
15. Special consideration must be taken when a single animal undergoes
multiple surgical procedures [AWA 2.31(d)(1)(x)].
Use the following questions to clarify the use of multiple surgeries in this protocol.
15a. Will multiple surgeries be performed on the same animal?
No – Go to item 16
Yes – Continue with item 15b
15b. Justify scientifically the necessity for using the same animal in
multiple surgical procedures:
Insert Text or "N/A" Here
15c. Indicate the minimum interval of time between procedures:
Insert Text or "N/A" Here
16. List potential adverse consequences and/or complications in this
research and associated remedial actions.
Investigator
Protocol #
7
Describe any adverse consequences and/or severe complications that may be seen as a result of this
research. Provide any remedial action that will be taken to counteract consequences and complications
(examples: loss of appetite, post-operative discomfort and/or infections, wound complications, selfinflicted or cage-mate-inflicted injury, anesthetic death, etc.).
Insert Text or "N/A" Here
17. Early removal criteria
List early removal criteria (such as particular animal behaviors, observations made by
investigators, etc. that would be signs indicating the need for early removal). This will enable a
prompt decision to be made by the Attending Veterinarian, Animal Facilities and the PI to
ensure that the end point is humane and the objective of the protocol is achieved.
Insert Text or "N/A" Here
18. Identify the appropriate medication (e.g., sedative, analgesic or
anesthetic) that will be used. If withholding such agents is necessary for scientific
reason, please provide justification and the necessary period of time that the medication
would be withheld.
Insert Text or "N/A" Here
19. Alternatives [AWA 2.31(d)(1)(ii)]
For any procedure that might potentially cause more than momentary or slight pain and
distress to the subject animals, the principal investigator MUST answer questions 1-9 in
this section AND provide a written narrative description of the methods and sources
used in the attempt to find alternate methods or procedures which are less painful or
distressful to the subject animals.
Database searching is the most effective and efficient method for determining whether or not
alternatives are available. There is no one database that reviews all the literature in all research
fields. A thorough search will require searching multiple databases. Listed below are some (but
not all) relevant databases.
AGRICOLA (10)
ASFA (44)
A-V Online (46)
Biological Abstracts
BIOSIS (5)
CAB Abstracts (50)
Education Abstracts (437)
Ei Compendex (8)
EMBASE (73)
FEDRIP (266)
International Pharmaceutical Abstracts (74)
Investigator
Protocol #
Life Sciences Collection (76)
MathSciNet (239)
MEDLINE (155)
Microcomputer Index (233)
NTIS (6)
Pascal (144)
Pharmaceutical News Index (42)
PsycINFO (11)
RTECS (336)
SciFinder Scholar [Chemical Abstracts] (399)
ISI Science Citation Index
8
ToxFile (156)
Zoological Record (185)
Note: Protocol approval is often delayed because of insufficient or poorly constructed database
searches. It is strongly suggested that you consult with a reference librarian regarding your
search. For assistance in formulating your search strategy, or in conducting the database
searches, please contact the Reference Librarian at the Ogg Science Library, Bowling Green
State University (419-372-2591).
The written narrative must summarize the results of the database searching and include:
1. The names of the databases searched.
Insert Text or "N/A" Here
2. The date the search was performed.
Insert Text or "N/A" Here
3. The period covered by the search.
Insert Text or "N/A" Here
4. The key words and search strategy (The logical keyword combinations, along with the
search operators that were used to combine the keywords, such as “AND”, “OR”, “NOT”, “ADJ”,
“NEAR”, “SAME”, “WITH”, etc.) used. Also include the search results, the number of “HITS” you
received for the search terms used. In some databases this information is available as a “search
history” that can be printed with the results. Be sure to use words such as “alternative” or
“model” in your search.
Insert Text or "N/A" Here
5. Any alternatives to live animals such as mathematical models, computer simulations or
in vitro biological systems, appropriate for the study, that were discovered through the
database searching.
Insert Text or "N/A" Here
6. Discussion of using a lower-order animal. If it would be possible to replace one species with
another not as high on the phylogenetic scale, supply justification for not using this lower-order
model.
Insert Text or "N/A" Here
7. Discussion of whether the search results showed a reduction in the number of animals
used would be possible.
Insert Text or "N/A" Here
8. Discussion of whether the search results showed any procedural refinements that would
lessen the pain or distress in the subject animals.
Investigator
Protocol #
9
Insert Text or "N/A" Here
9. Justification as to why a bona fide alternative method was not used, if an alternative
method or procedure was identified, and if it could have been used to accomplish the
goals of the animal use proposal.
Insert Text or "N/A" Here
Please provide a narrative in the text box below and attach the “search
strategy” or “search history” to the back of the signed protocol form.
(Note: If the study does not have the potential to cause more than momentary or slight pain and
distress to the subject animal you must state this. Do NOT leave this item blank.)
Insert Text or "N/A" Here
20. Unnecessary Duplication – Provide either:
A. Written assurance (in the box below) that the proposed activities do not
unnecessarily duplicate previous research/experiments/testing conducted by this
PI’s lab or by any other investigator. Explain how you determined that these
activities are not duplicative of previous work.
Methods for determining that there is no unnecessary duplication include, but are not
limited to:
a) A literature search
b) A description of recent peer review of the work, such as that which may have been
provide by a federal granting agency or at a formal presentation to colleagues.
c) Communications with relevant subject experts.
Insert Text or "N/A" Here
OR
B. If the proposed activities do duplicate previous work, justify the need for
this duplication in the box below (e.g., teaching protocols reviewed on a
by-student basis where the learning experience is not available at this
institution in any other course).
Insert Text or "N/A" Here
THEN
If your assurance is based upon a literature search, please provide the following (and attach the
search history to the back of the signed protocol form):
Investigator
Protocol #
10
1. The names of the databases searched.
Insert Text or "N/A" Here
2. The date the search was performed.
Insert Text or "N/A" Here
3. The period covered by the search.
Insert Text or "N/A" Here
4. The key words and search strategy (The logical keyword combinations, along with the
search operators that were used to combine the keywords, such as “AND”, “OR”, “NOT”,
“ADJ”, “NEAR”, “SAME”, “WITH”, etc.) used. Also include the search results, the number of
“HITS” you received for the search terms used. In some databases this information is
available as a “search history” that can be printed with the results. If any truncation or
wildcard characters were used, field qualification (searching only in the article title, abstract,
etc.), or limits applied, include this information.
Insert Text or "N/A" Here
If your assurance includes communications with subject experts, provide the following [and
attach any relevant hard copy documentation (e-mails, letters, etc.)]:
5. The date of the communication.
Insert Text or "N/A" Here
6. The name of subject expert.
Insert Text or "N/A" Here
7. The subject expert’s qualifications and relevance to the proposed work.
Insert Text or "N/A" Here
8. The amount of time spent in consultation regarding the proposed work.
Insert Text or "N/A" Here
9. A summary of your communication with the expert.
Insert Text or "N/A" Here
21. What will happen to the animal(s) at the end of this study?
Investigator
Protocol #
11
21a. If the animal survives the end of the study, what will happen to it?
Adoption
Euthanasia
Protocol transfer (if possible identify protocol(s) here 
Release (describe here 
)
Other (describe here 
)
)
21b. If the death of the animal is part of the protocol or necessary for other
reasons, list the method of euthanasia for each species to be used in this
protocol [AWA 2.31(d)(1)(xi), 2.31(e)(1)], [PHS Policy IV.C.1.g]. See the 2007 AVMA
Guidelines on Euthanasia for information regarding methods of euthanasia
(http://www.avma.org/issues/animal_welfare/euthanasia.pdf)
Animal/Species
Method
Agent
Dose (mg/kg)
Route of
Administrations
21c. How will death be determined? (List a primary and secondary means – see
Euthanasia SOP-160 at http://www.bgsu.edu/downloads/gradcol/file45043.pdf)
Insert Text or "N/A" Here
22. Will animals be caught in the wild?
No - go to item 23
Yes - describe the capture methodology to be used, then continue with question 22a
Insert Text or "N/A" Here
22a. Have appropriate collection permit(s) been obtained?
This includes local permits which grant access to property.
No – Obtain permit(s) and provide a copy of the permit(s) to the Office of Research
Compliance
Yes – Attach a copy of the permit(s) to the protocol
N/A
Investigator
Protocol #
12
23. Will animals be transported from the wild or from another institution to
BGSU?
No – go to item 24
Yes – provide the details of the transport below, including the precautions used to
ensure animal health and welfare. Then go to item 23a.
Insert Text or "N/A" Here
23a. Have necessary transportation permits been obtained?
No – Obtain permit(s) and provide a copy of the permit(s) to the Office of Research
Compliance
Yes – Attach a copy of the permit(s) to the protocol
N/A
24. Are any hazardous materials (biological, chemical, radioactive) used in
conjunction with this protocol?
No
Yes - (complete the table and sign-off section below)
For each hazardous material that is given to the animals (whether or not they are subsequently
housed in the UAF), list the following information in the table below:
Agent 1
Agent 2
Agent 3
Hazardous
Agent
Type of Hazard
Amount
administered
Route of
administration
Duration of
exposure of
animals
Will the hazard
be brought into
UAF (Yes/No)
How will hazard
be stored?
How will hazard
be prepared?
Will the hazard
be excreted or
shed by animals
while they are
Investigator
Protocol #
13
housed in the
animal facility?
(Yes/no)
Duration of
hazard in UAF
25. Assurance by Principal Investigator

I certify that this project will be conducted in full accordance with the PHS Policy on Humane
Care and Use of Laboratory Animals, the Animal Welfare Act and Regulations, and Bowling
Green State University policies governing the use of live vertebrate animals for research,
testing, or teaching purposes.

I understand that institutional approval is valid for a period of three (3) years following the
date of original approval with annual updates required. At the end of the three (3) year
period, this protocol shall be automatically inactivated and all animal activities covered under
it shall cease. To continue or add to these animal activities, submission and review of a new
animal use protocol is required. The new protocol will be assigned a new protocol number.

Should any changes occur (e.g., increase/decrease in number of animals, change of
technique, additional co-PI, etc.), I accept the responsibility to submit an appropriate
modification to IACUC for review prior to initiation of such changes or modifications.

I will keep a copy of the approved protocol and any associated approved addendum
requests in relevant animal housing and procedure rooms

I affirm that the information presented in this protocol accurately reflects the animal use in
any associated grant application submitted for either internal or external funding.

This research protocol will be reviewed in an open meeting and the information contained
herein may become otherwise publicly available under the open record act. If you feel that
all or part of your protocol is properly confidential, i.e., is: potentially patentable work, trade
secrets, proprietary information, work that could lead to or result in commercial
development, or (perhaps) other information related to your research which you deem to be
confidential, you may wish to have the protocol considered confidentially. If you decide to
request that the protocol be considered confidentially, do not sign this signature page.
Instead, ORC will provide, upon request, an alternate signature page for protocols
containing confidential information.

If this protocol involves the use of hazardous materials, I agree that all procedures involving
the storage, handling, use, and/or disposal of these materials will be performed in
compliance with BGSU’s:
 Hazardous Waste Manual: http://www.bgsu.edu/offices/envhs/page18352.html
 Institutional Biosafety Committee Guidelines: http://www.bgsu.edu/offices/orc/ibc
 Radiation Safety Program: http://www.bgsu.edu/offices/envhs/page18453.html
 Chemical Hygiene Plan: http://www.bgsu.edu/downloads/finance/file18401.pdf
 Laser Safety: http://www.bgsu.edu/offices/envhs/page107300.html
Investigator’s Name (type)
Investigator
Protocol #
Investigator’s Signature
Date
14