IACUC Annual Continuing Review Form
Date:
Protocol Year:
Year 1
Year 2
Expiration
Date:
Principal Investigator:
Protocol #:
Project Title:
The protocol specified above is due for annual continuing review by the IACUC as required by the USDA regulations and
our Federal Wide Assurance. To maintain approval status, return this form electronically to iacuc@uwosh.edu using your
UW Oshkosh user account for verification. This form must be completed and returned prior to the anniversary date or all
animal work under this protocol will become temporarily suspended. Please allow 2 weeks for the IACUC to complete the
annual continuing review.
Note: Please review your protocol application closely as you complete this form. Animal protocols and all IACUC forms
can be downloaded from TitanFiles or the Grants & Faculty Development website at: www.uwosh.edu/grants/forms
Please select one of the following:
Study is completed. Please close the file. (Answer questions below, sign form, attach any publications)
Study was never conducted. Please close the file. (Sign form)
Study is still in operation and will be used with no revisions. (Answer questions below and sign form)
Study is still in operation but modifications to the protocol are requested.
Modifications include: change in animal numbers >20% of original number approved, change in study
objectives, change in PI or Co-PI, change from non-survival to survival surgery, change in animal housing,
change resulting in greater pain, distress, or invasiveness, change in species used, change that may impact
personnel safety. (Answer questions below, sign, and attach an IACUC Protocol Modification Request form
found at www.uwosh.edu/grants/forms)
Study is still in operation but a small increase to animal use numbers is requested. A small increase is
considered ≤ 20% of original animal number(s) approved. (Answer questions below, sign, and attach an
IACUC Animal Number Increase Form found at www.uwosh.edu/grants/forms)
Study is still in operation but changes to veterinary care are requested. Modifications include change in
anesthesia, analgesia and/or sedation, change in experimental substance, change in euthanasia method (must
remain within current AVMA Guidelines), change in duration of procedure performed on animal, change in type
or frequency of procedure performed on animal, change in number of procedures performed, change in diet,
including food restriction. (Answer questions below, sign, and attach an IACUC Veterinary Care Modification
Request Form found at www.uwosh.edu/grants/forms)
1. Number of animals used in this protocol since the project approval date (please list by species):
Number of Animals
Last updated: 04/26/2013
Species of Animals
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2. During the past year, have there been any unexpected problems or complications?
Yes
No
If yes, please explain.
Note: Unexpected events or
problems involving your protocol
should be reported to the IACUC
within 72 hours (See SOP #24)
Self Audit of Approved Animal Care and Use Protocol
PROTOCOL AND PERSONNEL
1.
Do the PI and personnel all have access to the most recent version of this protocol and
(any) modifications?
Yes
No
N/A
2.
Do the PI and personnel have accurate knowledge of the protocol?
Yes
No
N/A
3.
Are all personnel who handle animals listed on the protocol? (Undergraduate students
may be listed as student research assistants TBD on approved protocols. The PI is
ultimately responsible for ensuring all students are trained.)
Yes
No
N/A
Have all personnel completed the Animal Care Certification class and all other required
training?
Yes
No
N/A
4.
STUDY PROCEDURES
5.
Are the procedures used the same as those described in the protocol?
Yes
No
N/A
6.
Are the species, strain, ages, and numbers of animals consistent with those in the
approved protocol?
Yes
No
N/A
7.
Have amendments been submitted for any changes in procedure?
Yes
No
N/A
8.
Are personnel wearing protective clothing (e.g. gloves, lab coat, etc.) appropriate for the
species and procedures?
Yes
No
N/A
Yes
No
N/A
10. Are pharmaceutical grade compounds being used (unless otherwise approved by the
IACUC)?
Yes
No
N/A
11. Are anesthetized animals being monitored according to what is written in the protocol?
Yes
No
N/A
12. Are anesthetic and analgesic dosages, frequency, and routes of administration
accurately recorded?
Yes
No
N/A
13. Is surgery done using aseptic technique?
Yes
No
N/A
14. Are all drugs, fluids, suture, etc. within the expiration dates?
Yes
No
N/A
15. Are scheduled drugs stored under lock and key and with appropriate records?
Yes
No
N/A
16. Do surgeon(s) wear masks, shoe covers, sterile gloves and lab coat?
Yes
No
N/A
17. Does the method of euthanasia correspond with what is written in the protocol?
Yes
No
N/A
18. Are animal carcasses disposed of promptly and recorded properly?
Yes
No
N/A
ANESTHESIA & ANALGESIA
9.
Are the methods of anesthesia and analgesia in compliance with what is written in the
protocol?
RODENT SURGERY
EUTHANASIA
By checking this box and printing my name below, I agree to conduct the project in accordance with the PHS Policy, USDA
regulations, Federal Animal Welfare Act, the Guide for the Care and Use of Laboratory Animals, and all relevant institutional
regulations and policies regarding animal care and use at the University of Wisconsin Oshkosh.
Last updated: 04/26/2013
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Signature of PI:
Date:
IACUC Use Only Below This Line
Status:
Ongoing without Revisions
Closed
Protocol Modification
Request
Animal Number Increase
Request
Veterinary Care Modification Request
Signature of IACUC Chair or Designee:
Date:
Comments:
Last updated: 04/26/2013
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