ANIMAL CARE COMMITTEE
ANIMAL USE PROTOCOL APPLICATION
FIELD BASED PROJECTS
The use of animals in teaching/research is a privilege. Before a protocol to
use animals is approved, the instructor/researcher must show that the use
of animals is justified, that the project has merit, and that the procedures to
which the animals will be submitted will be carried out humanely and in
accordance with Canadian Council on Animal Care standards.
For Administrative Use Only:
Protocol Number:
Date Received:
Start Date:
Period of Validity
End Date:
Please submit an e-copy of the completed Animal Use Protocol Application to acc@viu.ca.
Once approved, the Animal Care Committee will request a completed signed hard copy of the Animal Use
Protocol Application. Compliance with the approved protocol is mandatory.
As a form of post-approval monitoring for field studies, protocol holders must submit a
progress report to the Animal Care Committee upon renewal and/or expiry of this protocol.
For Administrative Use Only:
Signatures:
Committee Chair
Printed Name: _____________________________
Signature:
________
ACC Veterinarian
Printed Name:
_______
Signature:
________
Member at large
Printed Name:
_______
Signature:
________
For Administrative Use Only:
Project Info:
Principal Investigator:
__________________________________________________
Short Title of Project:
_______________________________________________________________________________________
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Please check one:
First Submission
Revision (include Application for Amendment form)
Resubmission (every 3 years)
I.
General Information
Purpose of Protocol:
Teaching (Also complete Appendix A Description of Educational Value)
Research (Also complete Appendix B Summary of Scientific Merit)
Current Protocol Number (not required for First Submission):
Course Number(s) and/or Descriptive Project Title:
Anticipated Start and End Dates for Protocol Activities:
Principal Instructor/Investigator:
Dr.
Academic Position:
Faculty
Mr.
Ms.
Technician
Other (please specify)
Vancouver Island University Department:
Location of Study:
Please provide location of study, being as specific as possible. Please
include UTM co-ordinates or lat/long if known:
Office Address:
Telephone Number (Office): (
)
ext.
E-Mail Address:
Declaration: I, the undersigned, assure that all animals used in this
proposal will be cared for in accordance with the guidelines of the
Canadian Council on Animal Care and Vancouver Island University.
Declaration: I, the undersigned, am aware of the human and facilities
resources required for undertaking this project.
Dean, Faculty of
Vancouver Island University
Principal Instructor / Investigator:
Signature
Name:
Signature
Name:
Date: (yyyy-mm-dd)
Date: (yyyy-mm-dd)
II. Lay Summary of Project:
Summary of protocol and justification for animal use, including educational or research value and
procedures to be used. (Use LAY language, suitable for a press release and public presentation. < 300 Words)
III. Keyword Description of Protocol
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IV. Personnel and Qualifications
a. Staff and Training
NAME (last, first)
POSITION / DEPT.
CCAC Core
Training
Completed?
(all 4 modules)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Other Training /
Qualifications (Specify)
(including other CCAC
modules)
SIGNATURE
(Indicates individual has read
this AUP – scanned/emailed
signature acceptable for off
campus personnel)
For information on CCAC Training through VIU’s online system please contact acc@viu.ca or visit viu.ca/animalcare.
b. Emergency Personnel
List two people who will be available to assist in the field in an emergency situation (e.g. animals in traps and investigator injured, etc.)
NAME (last, first)
c.
POSITION / DEPT.
Work Phone
(
)
ext.
(
)
ext.
Home Phone
Additional Assistance Personnel
List person(s) who may be required to ensure that the project will be carried out in a competent and humane manner, (i.e., Veterinarian Consultant
or other specialist below.)
NAME (last, first)
POSITION / QUALIFICATIONS.
Work Phone
Home Phone
Signature
d. State conditions under which these personnel will be contacted.
e.
For teaching protocols what will the ratio of instructors to students be in this project?
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V. Protocol Categories
a. Purpose of Animal Use (PAU)
Choose the item (1-5) below that best describes the purpose of animal use:
1.
Studies of a fundamental nature in sciences relating to essential structure or function (e.g., biology, ecology,
psychology, biochemistry, pharmacology, physiology etc.)
2.
Studies for medical purposes, including veterinary medicine, that relate to human or animal disease or disorders.
3.
Studies for regulatory testing of products, for the protection of humans, animals, or the environment.
4.
Studies for the development of products or appliances for human or veterinary medicine.
5.
Education and training of individuals in post-secondary institutions or facilities.
b. CCAC Category of Invasiveness
CCAC Category of Invasiveness: : http://www.ccac.ca/en_/standards/policies/policy-categories_of_invasiveness
A
Procedures involving invertebrates (excluding cephalopods) or live isolates.
B
Procedures which cause little or no discomfort or stress.
C
Procedures which cause minor stress or pain of short duration.
D
Procedures which cause moderate to severe distress or discomfort.
E
Procedures which cause severe pain near, at, or above the pain tolerance threshold of unanaesthetized conscious
animals.
VI. Animal Information
a. Scientific Name
Common Name
Number Per
Year
Indicate Target
Species (T) or
Non-target (N)
b. Justify the use of live animals. Please include possible replacements considered and why these are not being used.
List the sources and databases searched for alternatives to the use of animals. (Suggested reference: CCAC Resource Centre web page
http://www.ccac.ca/en_/resource-centre)
c.
Justify the choice of species and strain.
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d.
Justification of Numbers
Use statistical or pedagogical arguments to justify the number of animals used.
e.
Non-target species
If applicable please indicate what steps will be taken to minimize the capture of non-target species and what will be
done with any non-target species caught.
f.
Regulatory Requirements. Copies of all authorizations are to be included with approved and filed protocol.
Verification of permits listed as pending must be forwarded to the ACC prior to the start of the project.
Collection Permit(s)#
Transport Permit #
Biohazards (specify)
Prescriptions (specify)
Controlled Substance (specify)
Other (specify)
VII. Describe Procedures Involving Animals
a. Please check all procedures that apply to this project.
Capture Methods:
minnow trap
mist netting
other fish trap
long-worth trap
electrofishing
mammal cage trap
seine netting
hand capture
gill netting
Other:
dip netting
Marking Methods:
fin clip
internal radio transmitter
ear/fin tag
external ratio transmitter
leg-band
elastomer
paints or dyes
Other:
PIT tags
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b. Describe, in detail, all procedures. Use language that can be understood by a trained biologist. Refer to approved SOPs
wherever possible. Be sure to include any variations to the relevant SOPs. If experimental drugs will be used, describe the
known effects. Details regarding how the animals will be monitored are addressed in Section X of this form. For resubmission,
highlight major scientific findings and describe procedural improvements.
**Box will expand to accommodate text that is inserted **
Procedure
Person Performing
Qualified in the Procedure Y/N
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
5.
Yes
No
If no, who is responsible for
procedure training?
c. Euthanasia:
In the event an animal has to be euthanized, will CCAC Recommended Procedures be used?
Yes
No
In either case, please specify method of euthanasia if not already covered in Section VII.a. Refer to SOPs if appropriate. Please
note: Physical means without anaesthetics will need to be justified and competence demonstrated in the presence of an ACC
representative.
VIII.
Drugs and Chemicals
Are any drugs and/or chemicals being used in this project, including drugs and chemicals used for Euthanasia?
Yes
No
If ‘yes,’ complete Sections A, B, and/or C, following below:
A. Euthanasia: In the event drugs need to be used to euthanize an animal, provide the details below for each species. For fish,
refer to page 64 in the guidelines at http://www.ccac.ca/Documents/Standards/Guidelines/Fish.pdf.
Drug
Dosage
Route
Person Responsible
B. Anaesthetic agents (not including euthanasia agents): Give details of the anaesthetic regime to be used. Include dosages,
maximum volume allowable per animal per administration site (*See Guideline), and routes of administration for each species.
Name the person(s) who will administer and monitor anaesthetic.
Drug
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Dosage
Route
Person Responsible
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C. Experimental Drugs and Treatments (incl. drugs used in protocol, e.g., analgesics, tranquilizers, antibiotics. etc.) List all
experimental, prophylactic and therapeutic drugs, chemicals and biologicals that may be used. Give dosages, maximum volume
allowable per animal per administration site routes of administration, and duration. Name the person(s) who will administer
the agent(s). If the experimental drug is proprietary, provide class of drug. (*See CCAC Guidelines for fish, pg. 57)
http://www.ccac.ca/Documents/Standards/Guidelines/Fish.pdf)
For other animals, see Guidelines on Antibody Production – Appendix B
http://www.ccac.ca/Documents/Standards/Guidelines/Antibody_production.pdf
Analgesics
Drug
Dosage / Frequency / Duration
Route
Person Responsible
Tranquilizers
Drug
Dosage / Frequency / Duration
Route
Person Responsible
Antibiotics
Drug
Dosage / Frequency / Duration
Route
Person Responsible
Other
Drug
Dosage / Frequency / Duration
Route
Person Responsible
What are the expected and possible side effects of these drugs?
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IX. Dangerous Materials and Procedures
A.
Hazardous Agents. Will any hazardous agents be used in this project?
Yes
No
If 'yes', indicate the agent(s) below
Chemicals
Biohazards
Flammables Liquids or Gases
Compressed Gas
Flammable and Combustible Material
Oxidizing Material
Poisonous and Infectious Materials
Corrosive material
Dangerously reactive material
Bacteria
Viruses
Parasites
Fungi
Prions
Toxins
DNA recombinants
Genetically modified organisms
Viral vectors
Synthetic DNA and synthetic biology
Cell lines
Blood and body fluids
Radiation
Radioisotopes
x-rays
B. Occupational Health and Safety Risks.
Please check the occupational Health and Safety risks associated with this project.
Physical Risks
Cuts (e.g. use of needles, sharps, etc.)
Bites and Scratches
Lifting and handling loads manually
Highly repetitive motions
Slipping and Tripping Hazards
Moving parts of Machinery
Working at Height
Pressurized systems
Vehicles
Fire
Electricity
Excess noise (e.g. fans, compressor)
Extreme Temperatures
Vibration
Dust
Biological Risks not listed above
Sewage
Effluent
Exposure to zoonotic disease
Other Risks
Working alone
Working in remote/isolated area
Other (please specify):
For any of the above that could affect animal welfare (for example cutting yourself during an animal surgery, being bit by animal
during handling), please indicate how risks will be minimized. If has been covered in Section VII. a. Procedures, please indicate.
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X. Humane Monitoring, Intervention and Endpoints:
See pages 59 – 62 for Fish http://www.ccac.ca/Documents/Standards/Guidelines/Fish.pdf and
http://www2.viu.ca/animalcare/GuidelinesforChoosingAppropriateInterventionandEndpoints.asp
Frequency of monitoring animals and/or traps:
Who is responsible for monitoring animals and/or traps?
Name:
Contact number:
Humane Intervention and Endpoints: In the event that your project leads to a life-threatening condition, please describe the
intervention and endpoints for the animal that will lead to treatment and/or humane euthanasia respectively. The endpoints should
incorporate time and/or condition and be applicable to individual animals (e.g., weight loss, loss of equilibrium, etc.). (See CCAC
Guidelines for Endpoints - http://www.ccac.ca/Documents/Standards/Guidelines/Appropriate_endpoint.pdf)
Describe how the following aspects of the animal may change in the course of this experiment/teaching exercise and
which particular changes will signal action required to reduce or relieve animal distress.
Animal
activity
Possible changes
or complications
Signal for intervention
Intervention
Feeding
activity
Physical
appearance
Clinical signs
Unprovoked
behaviour
Provoked
behaviour
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Who is responsible for determining an intervention point has been reached?
Name:
Contact number:
Who is responsible for determining if humane euthanasia is indicated, based on the presence of a specific endpoint(s)?
Name:
Contact number:
Explain the chain of communication for the results of monitoring so that the process from observation to intervention is clear.
For experiments in which animals are evaluated beyond the initial experimentation procedure (i.e., after surgery), including
experiments in which no anaesthetic is administered: Include the expected numbers and the expected cause of morbidity and
mortality. This does not include mortality due to euthanasia.
Expected Morbidity:
Expected Cause:
Expected Mortality:
Expected Cause:
XI. Fate of Animals
What will be the ultimate fate of the animals? What will happen to animals not euthanized and how will euthanized animals be
disposed of? What steps, if any, will be taken to ensure any impacts of stress associated with handling are minimized postrelease (if applicable and not covered in Section VII)?
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APPENDIX A
Description of Educational Value
(Must be completed for teaching projects)
Please describe the educational merit of this project, relating it to the course and program’s learning objectives.
Databases:
List the sources and databases searched for alternatives to the use of animals.
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APPENDIX B
Summary of Scientific Merit
(Must be completed for research projects)
**Please read Peer Review Guidelines, http://www.viu.ca/animalcare/PeerReviewofScientificMeritofResearch.asp before filling
out Appendix B**
Potential Benefit of the Research
Specific scientific objectives and potential value. (This can be brief if exemption “a” of the peer review applies)
Peer Review:
Has this research proposal been previously peer reviewed?
Yes
No
If “yes,”
Name(s):
Internally
Externally
Funding Information
Source of Funds
Funds Administered by:
Vancouver Island University  Cost Centre Number:
Funding Agency:
(Required for invoicing of project costs)
Status:
Internal
External
Awarded
Pending
Other
Provide Details
Secondary Funding Agency::
Internal
External
Status
Awarded
Pending
Funding Start Date: (yyyy-mm-dd)
Funding Finish Date: (yyyy-mm-dd)
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