CONTINUING REVIEW OF A PROTOCOL FOR USE OF ANIMALS IN RESEARCH OR TEACHING
IUPUI School of Science Institutional Animal Care and Use Committee (IACUC)
Submit to: IACUC, c/o School of Science, LD 222, 402 N. Blackford Street, Indianapolis, IN 46202-3276
Principal Investigator (P.I.):
Protocol #:
Title:
Protocol origination date
Approved Species:
Approved Total
Amendment dates:
Attach any additional information for each question on a separate document if needed
1.
Have any significant changes been made since the last protocol review or amendment:
____No ____Yes (if yes, submit an amendment form with this continuing review)
2.
Number of animals purchased or weaned since last review (indicate genus):
___________________________________________________________________
Number of animals purchased or weaned since project origination (indicate genus):
___________________________________________________________
3.
Names of all personnel involved in this project since last review (indicate new personnel)
University policy on Anesthetic Gas Safety requires researchers and staff to complete an on-line training course before using anesthetic gases
http://ehs.iupui.edu/training.asp?content=anesthetic-gas-safety
P.I.__________________________________
___________________________________
____________________________________
_______________________________________
_______________________________________
_______________________________________
4.
Describe problems or concerns encountered, especially problems of animal pain or distress:
Was the attending veterinarian consulted and if not, why? ____N/A ____Yes
5.
[4-A] Have alternatives to this use of animals [4-B] and to procedures involving more than momentary pain or
distress appeared since protocol approval? ___No ___Yes (if yes, justify continued animal use)
Specify sources consulted; for databases, give keywords (for alternatives and procedures), years
searched (>=10 years), and date of search (“alternative” or equivalent must be a keyword)
6. What is the funding and status of this project?
Submitted agency and title: _____________________________________________________
Source of funds and title: ________________________________________________________
 Not initiated (anticipated initiation date:
)
 Will not be initiated*
 Check if ONGOING
 Completed*
*Automatically terminated if selected
Principal Investigator ____________________________________________ Date
OFFICE USE ONLY:
Final Expiration Date: Three years from Protocol origination date
APPROVED
DISAPPROVED
TERMINATED
SOS IACUC Signature:
Date:
Attending Veterinarian Signature
Date
SOM IACUC Signature
Date
Continuing Review of a Protocol Version 7/23/14-ckk