INSTRUCTIONS - READ CAREFULLY
IACUC FORMS:
1. All IACUC forms are available for downloading from the Forms web page.
Forms must be typed, except that boxes may be marked in ink. Handwritten forms will not be reviewed.
2. Due to regulatory requirements, all questions must be fully answered. If a question or part of a question
does not apply to your project, so indicate by typing “not applicable” or “NA”.
3. You may use additional sheets to describe animal use procedures, or you may make additional space on the
form as needed.
4. Incomplete forms cannot be approved. Please call Doug Fitts (206-685-0784) or Tena Petersen (206543-9678) if you have questions about the form.
SUBMISSION CHECKLIST FOR IACUC PROTOCOL FORMS:
1. Submit a typed, single-sided copy of the completed Project Review Form (PRF)
2. Submit to the UW Office of Animal Welfare at Box 357160 or email a PDF file to OAW.
APPROVAL PROCESS FOR NEW PROTOCOLS AND OTHER PROTOCOL FORMS:
1. New IACUC protocols are assigned a 6 digit number. The first 4 digits indicate the PI and the last 2 digits
indicate, in chronological order, the specific protocol.
2. The Project Review Form is made available to the entire IACUC in the next available mailing to Committee
members. This is usually within 2 weeks of receipt of the form.
3. You may be requested to submit additional information or to revise the protocol as a result of the initial
review by IACUC members. Written response to such requests is required - failure to respond will result in
discontinuation of the review process and the protocol remaining unapproved.
4. Any IACUC member may request discussion at the next available IACUC meeting (i.e., "Full Committee
Review"). Full Committee Reviews are typically conducted for protocols with substantive IACUC
questions during the initial review process, or for protocols with a potential for unrelieved animal pain.
5. You will be notified, in writing, regarding approval of the project. Do not assume that you have approval if
you have not received the written approval letter (or verification by e-mail).
IF YOU NEED HELP:
1. For general help/questions concerning filling out the PRF or the approval process, please call Doug Fitts
(206-685-0784) or Tena Petersen (206-543-9678).
2. For questions regarding registration for Animal Use Training sessions (AUTS), refer to the information on
UW web training site at http://depts.washington.edu/auts/.
3. For help determining animal housing location in a Comparative Medicine vivarium, contact Pam Morris
(543-0641or pcm252@u.washington.edu).
4. For help with issues such as appropriate anesthesia, analgesia, etc., contact Veterinary Services
(vsreview@u.washington.edu).
5. For help concerning Occupational Health, Research & Biological Safety Office (206-221-7770 or
rbso@u.washington.edu).
6. For help regarding hazardous agents, contact the Research & Biological Safety Office (206-221-7770 or
rbso@u.washington.edu).
University of Washington
Institutional Animal Care and Use Committee
Protocol # ___________________
PRF-1
PROJECT REVIEW FORM
Submit completed form (single-sided) to: Office of Animal Welfare, Box 357160
Please check one:
This is a new project or
IACUC Protocol PI:
Department:
Phone #:
E-mail :
Co-Investigator(s):
Project Title:
Planned Project Dates:
This is a 3-year renewal of Protocol #
Faculty Title:
FAX #:
Box #:
Funding Source(s):
Review for Scientific Merit
All animal use projects must be reviewed for scientific merit prior to initiating animal use. The required
review for this project (please check one):
has been conducted by my department or school and has been found to be scientifically
meritorious (signature of Chairperson or designee required). The review was conducted by:
_________________________________________________________
committee)
_____________________________________________________
Chairperson
(name
of
reviewer(s)
or
review
__________________________
Date
will be conducted by a funding agency prior to the start of the project ______________________
(agency)
has already been conducted and approved by a funding agency ____________________________
(agency)
(ANIMAL CARE COMMITTEE USE ONLY - DO NOT WRITE BELOW THIS LINE)
Animal Use Categorization: ___________________________
CTC: _____________________________
Comments:________________________________________________________________________________________
_________________________________________________________________________________________________
Data entry: ___________________________
Date: ______________________________
Designated Reviewer (if applicable): _________________________________
Date Approved by IACUC: _________________________________________(Approval expires one year from this date)
PRF Template Revised by Office of Animal Welfare 06/29/12
University of Washington
Institutional Animal Care and Use Committee
PRF-2
Principal Investigator Certification Statement
1.
I understand that all use of animals must have prior IACUC approval. I understand that unauthorized
animal use is reportable to the funding agency and the Office of Laboratory Animal Welfare (OLAW).
Therefore, I will obtain approval prior to animal use and prior to instituting any significant
changes in the project. I understand that certain funding agencies (e.g., NIH) require specific approval
for use of their funds to cover costs incurred (per diem, salary, etc.) during a period of non-compliance
or complete lapse in IACUC approval.
2.
I certify that this Project Review Form accurately describes all aspects of the proposed animal usage
and that the proposed work is not unnecessarily duplicative.
3.
I accept responsibility for ensuring that all personnel working on this project are aware of, and will not
deviate from, the IACUC approved procedures outlined on this form, that they will adhere to the
regulations regarding the humane treatment of laboratory animals and that they will receive proper
training as required by the IACUC.
4.
I understand that if I (or the contact person listed on this form) cannot be contacted and animals on this
project show evidence of illness or pain, emergency care (please indicate contraindicated drugs under
Section 2, item #31), including euthanasia may be administered at the discretion of veterinary staff.
5.
I understand that the approval is not final until I receive notification of such in writing, and that the
IACUC can recommend or require changes to the protocol.
6.
I understand that approval of projects is for a maximum of one year from the date of IACUC approval
and I must apply for a renewal in order to continue the project beyond that period.
__________________________________
Signature of P.I. (no per signatures)
__________________________
Date
Animal Use Personnel Certification Statement
(All animal use personnel must sign prior to submittal of form additional personnel can be added later, by submitting a New Personnel Form )
I certify that I have read this Project Review Form and that I will perform only those procedures that have
been approved by the IACUC. I understand that any Significant Changes in procedures must be approved by
the IACUC prior to implementation.
Printed Name & Signature
_______________________________________
_______________________________________
_______________________________________
Printed Name & Signature
_______________________________________
_______________________________________
_______________________________________
University of Washington
Institutional Animal Care and Use Committee
PRF-3
SECTION I
A. Using language understandable to non-scientists, describe the goals and significance of the project to
human/animal health or biology.
B. If this is a 3-year renewal, please provide information requested in the next 2 items:
1. Have there been any unexpected adverse events, morbidity, or animal mortality in the past year? If so,
explain the cause and measures taken to prevent future occurrences.
2. Please provide a brief report of progress to date on this project.
University of Washington
Institutional Animal Care and Use Committee
PRF-4
C. Provide a description of the proposed animal studies to be conducted over the next 3 years. For each
species on the protocol, in language scientific colleagues outside of your discipline would understand, provide
the sequence of events to reveal what will happen to the animals. For complicated experimental designs, a
flow chart, diagram, or table is strongly recommended. Do not describe the details of procedures here. Please
note, the IACUC cannot approve your protocol unless the entire sequence of events that an animal will
experience is clear - from enrollment in the study to the final endpoint. Do not simply attach a grant or e-GC1
abstrac
D. Occupational Health Protocol Hazard Questionnaire (Note: some information may be redundant with other
parts of the protocol but completion of the brief questions below will expedite review for Occupational Health
issues.)
Date:
New Protocol:
3-Year Renewal:
Contact Person Phone:
Contact Person:
Human Tissue/Cell Lines
Type:
Using Sharps
Type:
Infectious Agents in Animals
Type:
Toxic Agents:
Type:
Personal Protective Equipment to be
used:
Fixing Tissues
Type:
Agent:
Chemical Agents/Drugs administered
to animals:
Type:
Procedures for safe needle/sharps use
and disposal:
Yes:
No:
University of Washington
Institutional Animal Care and Use Committee
PRF-5
Contact Person (e.g., questions):
_________________________________________ Phone: ___________________ Box: _________________
(Name)
E-mail: _________________________________________
E. Complete for PI and Personnel:
PLEASE NOTE:
1. All individuals working with live vertebrate animals, and the protocol PI, must complete federally required training on
the pertinent laws and regulations. This training must be completed every 5 years (list latest date below). This
requirement must be met prior to inclusion on this form. Do not list future dates. New Personnel can be added
later if the training has not yet been completed or if a person's training has expired and is not yet updated.
2. Provide the information requested below. Use additional pages as needed.
3. Information must be complete for each person or they will not be approved as protocol personnel.
4. If no one is included to perform certain tasks (for example a person trained for surgery), indicate that you intend to add
someone to the protocol with the appropriate skills prior to initiation of the project.
Required information for each person to be added (use additional pages as needed):
Name:
UW E-mail (and other if applicable) :
Position:
Campus Phone (if available):
Department:
Box # (if available):
For this IACUC protocol:
a. List each species you will handle:
b. Indicate years of experience with each species:
c. Check duties specific to this protocol below – repeat for each species:
Species:
Anesthesia
Orbital Bleeding
Cervical Dislocation
Orbital Injections
Decapitation
Survival Surgery
Handling
List Other Duties Here:
d. Describe experience for duties listed above in item “c”. If none, indicate how you will be trained (e.g.,
will be taught by PI or personnel approved on protocol). NOTE: OAW will list your pertinent UW
courses below – no need to list them here.
e. If duties include performing survival surgery or administration of anesthesia:
i. Years of experience performing survival surgery at UW (list by species):
ii. Years of experience performing anesthesia on animals at UW (list by species):
University of Washington
Institutional Animal Care and Use Committee
PRF-6
F. In the table below, list requested BUILDING AND ROOM # for animal housing location(s).
Housing Locations
Species
Yes
Long-term (24 hrs or more)
Building & Room #
Short-term (single night)
Building & Room #
No
Have you requested housing (short-term or long-term) in a space that is not a dedicated
housing room (i.e., PI lab or hood within a PI lab)? Please contact the Office of Animal
Welfare if you are unsure as to how you should answer this question.
a. If “yes”, provide an explanation of the scientific necessity for housing animals outside a
Centralized vivarium or dedicated housing room. Please note that regulations do not allow
the IACUC to approve housing in laboratories solely for reasons of convenience.
G. In the table below, list requested BUILDING AND ROOM # for animal use location(s).
Species
Surgery Location(s)
(Building & Room #)
Non-Surgical Procedures & Locations
Name of Procedure
Location (Building and Room #)
University of Washington
Institutional Animal Care and Use Committee
PRF-7
H. Indicate the planned number of animals for the next 3 years (complete relevant tables).
a. New: animals to be purchased:
Species
Strains
Sex
Ages
Size
Number
b. Breeding or Births: Anticipated number of animals to be born as a part of this protocol:
Species
Strains
Number
c. Transfers: Animals to be acquired from another approved protocol:
Protocol #
Species
Strains
Sex
Ages
Size
Number
d. Capture: Anticipated number of animals to be captured as a part of this protocol:
Species
Ages
Size
Number
e. Carry-over: Animals you currently have in house, to be continued on this project:
Species
Strains
Sex
Ages
Size
Number
Animal Order/Purchase By:
Comparative Medicine
Primate Center
Veterinary Medical Care By:
Comparative Medicine
Primate Center
Veterinary Medical Care By:
Other (Note: pre-approval required) ___________________________________
University of Washington
Institutional Animal Care and Use Committee
PRF-8
I. NOTE: There are Federal policies regarding documentation that reduction, replacement, and
refinement (the three R’s) have been addressed. For all studies, a literature search (or other
documentation) is required to determine that
1) there are no non-animal alternatives available and that
2) less painful/distressful alternatives to your proposed animal use and procedures are not available or
feasible.
Was a literature search performed?
Yes
No
If “Yes”, you must provide the following information (or the protocol cannot be approved):
Databases/Sources
Date of Search
Years Searched
Key Words or Strategy to find
alternative to animals AND potential
alternatives to painful/distressful
procedures
J. If “No”, please describe, in detail, the methods you used to determine that alternatives to your use of
animals, or that less painful/distressful procedures, are not available or feasible. It is insufficient to
simply state that there are no alternatives. You must explain how you know that to be the case.
K. ASCITES: Federal policies require that investigators planning production of monoclonal antibodies
by the mouse ascites method, specifically address the reasons that in vitro methods cannot be used.
NOTE: If the antibody is commercially available as an “off the shelf” product, the ascites method
cannot be used in lieu of purchasing it.
L. Describe alternatives to animal use you may employ (or have employed) in this project. Alternatives
should reflect refinement, replacement, and reduction of animal use. These include in vitro tests, use of less
sentient animals, use of fewer animals to attain statistical significance and use of methods to decrease
animals’ sensitivity to pain.
University of Washington
Institutional Animal Care and Use Committee
PRF-9
M. Describe the rationale for using animals and the appropriateness of species proposed.
N. Provide in detail the method used to determine the number of animals that you will need over the next
3 years. Inclusion of a Power Analysis is expected, if preliminary data are available for the necessary
calculations (use additional pages as needed). For studies where Power Analysis is not appropriate
(e.g., pilot studies, tissue protocols, etc.), provide a narrative describing how requested animal
numbers were determined. Be sure to explain how you determined group sizes, the planned groups
necessary, etc. A statement such as “We will use 5 animals per group and 3 groups and therefore
need 15 animals is NOT sufficient.”
University of Washington
Institutional Animal Care and Use Committee
PRF-10
SECTION II
ANIMAL USE PROCEDURES: Mark the box (either “yes” or “no”) for every procedure. If a
procedure is marked “yes”, answer each part of that question. Make additional space as needed or use
additional sheets. If a specific part of that procedure is not applicable to your project, so indicate (e.g., type
“NA”). Note: You must provide specific timelines for all procedures, including the endpoint of the study for
each animal.
Please review information on IACUC policies regarding specific procedures. Adherence to the published
policies will facilitate review and approval of procedures.
If public release of this form is requested under the Freedom of Information Act, I wish to have input to
ensure that information revealing the experimental hypotheses or design is not released to the public.
#
1.
Yes
No
Anesthesia (include pre-anesthetic and anesthetic agents):
a. Provide the information requested in Table form.
Animal
Species
Anesthetic
Agent
Dose
(mg/kg for
injectables)
Route
Procedure
(e.g., surgery, blood draws)
b. For gas anesthesia, what is the method of scavenging of waste gases (e.g., FAIR canister,
fume hood)?
c. What parameters will be monitored to ensure adequate anesthesia (e.g., corneal reflex,
heart rate, respiration, front toe pinch for Ketamine/Xylazine, etc.).
2.
Ether use (not recommended)
a. Scientific justification for use of ether (required)
b. Fume evacuation method
c. Most recent certification date of fume hood
d. Room where ether will be used
e. Storage method and location
University of Washington
Institutional Animal Care and Use Committee
#
Yes
PRF-11
No
3.
Paralytic agents (anesthesia required)
a. Agent
b. Dose
c. Volume (required for rodents only):
d. Route of administration
e. Monitoring protocol to ensure adequate anesthesia
f. Scientific justification for use of paralytic agents
4.
Administration of drugs/reagents/non-human cells (specify species)/etc. (Answer all
parts for each agent and animal species. For hazardous agents (including human cells)
answer under #5 below. For antibody or ascites production, answer under # 7 and/or 8
below):
a. Agent
b. Dose(s)
c. Volume(s) (required for rodents only):
d. Route of administration
e. Frequency and duration of administration
f. Intended effects and potential side effects on animals
g. Monitoring protocol, including frequency, duration & specific behavioral and clinical
signs being monitored
h. Planned Endpoint:
Euthanasia
Spontaneous Death
Other (explain)
5.
Potentially hazardous agents (answer all parts for each agent)
NOTE: Include all hazardous chemicals, radioactive materials, and biohazardous agents in
animals. If working with biohazardous agents, you must obtain separate approval from the
Institutional Biosafety Committee (IBC). Submit the IBC Biological Use Authorization (BUA)
Application or IBC Request for a Change to Biological Use Authorization (BUA) form to
initiate this process:
http://www.ehs.washington.edu/rbsresplan/bua.shtm. Examples of biohazardous agents
requiring IBC approval are the following: bacteria, viruses, parasites, human cells, and all
recombinant DNA (e.g. plasmid DNA, siRNA, viral vectors, any cells with recombinant DNA,
and recombinant bacteria). IBC forms should be submitted at the same time as your IACUC
protocol to avoid delays. If you have questions, contact the EH&S Research and Occupational
Safety at 206-221-7770 or ehsbio@uw.edu.
a. Agent
b. Dose(s)
c. Volume(s) (required for rodents only):
d. Route of administration
e. Frequency and duration of administration
f. Intended effects and potential side effects on animals
g. Monitoring protocol, including frequency, duration & specific behavioral and clinical
signs being monitored
h. Potential danger to humans
i. Precautions to protect personnel
j. Special containment requirements
k. Special disposal requirements for agents and animals
University of Washington
Institutional Animal Care and Use Committee
#
Yes
PRF-12
No
l. Planned Endpoint:
Euthanasia
Spontaneous Death
Other (explain)
University of Washington
Institutional Animal Care and Use Committee
#
6.
Yes
PRF-13
No
Toxicity testing
a. Agent
b. Testing protocol
c. Intended effects and potential side effects on animals
d. Monitoring protocol
e. Endpoint:
Euthanasia
Spontaneous Death
Other (explain)
7.
Will you administer cells, cell lines, sera, or other biologicals to RODENTS:
a. If yes, please contact Dr. Susan Dowling (221-3933, sdowling@u.washington.edu)
regarding the cells to be used on this project to determine what testing (e.g. MAP) may be
required prior to administration to rodents.
I have already contacted Dr. Dowling and discussed this issue.
I have not yet contacted Dr. Dowling but I will contact her prior to start.
8.
Antibody production (for ascites production, skip to #9 below) (Note: If you plan to
purchase custom antibodies from a private company instead of producing them yourself, you do not
need to answer this question. However, the company you use must have an Animal Welfare
Assurance on file with OLAW. Most assured companies are listed at:
http://grants1.nih.gov/grants/olaw/assurance/300index.htm)
a. Provide the information requested below if you will be using animals to produce
antibodies.
Immunizing Agent
(antigen)
Adjuvant
Number and Site(s) (IP,
IM, SQ, etc.) of
inoculation
Volume per
inoculation site
Primary
Immunization
Booster
Immunization
9.
Ascites Production
a. Species (e.g., mice)
b. Priming agent (e.g., Pristane)
c. Injection volume (for mice, not to exceed 0.2ml for Pristane)
d. Route of administration
e. Hybridoma cell injection protocol (e.g., dose, # days after priming)
f. Monitoring protocol, including frequency, duration & specific behavioral and clinical
signs being monitored (minimum required following initial inoculation: 3 times/week the
first week and daily thereafter)
g. Ascites collection protocol, including number of taps, needle size, etc. (note: euthanasia
required after 2nd tap, unless scientifically justified)
University of Washington
Institutional Animal Care and Use Committee
#
Yes
PRF-14
No
10.
Tumor transplantation/induction or spontaneous growth
a. Type of tumor (for implants specify species of origin – e.g., human, mouse)
b. Site
c. Functional deficits expected
d. Monitoring protocol, including frequency & specific behavioral and clinical signs being
monitored (at least 3 times per week required)
e. Provide assurance that animals will be euthanized before tumors exceed 10% of normal
body weight or provide scientific justification for larger tumors
11.
Blood Sampling (answer for each animal species)
a. Species
b. Method
c. Site
d. Volume (describe monitoring/replacement therapy if greater than 10ml/kg in a 2 week
period)
e. Frequency
12.
Imaging procedures (radiographs, ultrasounds, MRI, etc.)
a. Is the imaging location (building & room #) listed in section G of this form? If not,
please add this information.
b. Type of procedure
c. Will animals be anesthetized (if yes, be sure to list anesthetics in item #1)
d. Frequency
e. Duration of each imaging session
f. Purpose (e.g., imaging only, tumor treatment, etc.)
g. Effects on animals
h. Will supportive care of animals be necessary? If yes, describe.
13.
Use of restraint (not applicable for brief restraint such as holding for blood sampling)
a. Species
b. Method
c. Frequency
d. Duration of restraint
e. Scientific justification for prolonged or painful restraint
14.
Implanted catheters, prostheses, etc. (describe applicable surgery under # 16)
a Type
b. Site
c. Monitoring protocol, including frequency & specific behavioral and clinical signs being
monitored
d. Maintenance and care of chronic implants
e. Method used to sterilize implants
f. Will it be necessary to surgically re-implant or repair implants that have failed? If so,
please describe the circumstances that would require a repair or replacement. (Include
request for repair surgeries in the applicable sections of the Multiple Survival Surgeries
table under question #16.)
University of Washington
Institutional Animal Care and Use Committee
#
Yes
PRF-15
No
15.
Terminal surgery (i.e., no recovery from anesthesia)
a. Describe surgical procedure
b. Duration of procedure
16.
Survival surgery – repeat this item for each surgical procedure
a. Name of surgery or surgical procedure
b. Number of surgeries per each animal
c. Describe surgical procedure(s)
d. Pre-operative protocol (e.g., food/water restriction, animal prep.)
e. Aseptic precautions (must include method of instrument sterilization prior to initial use
and between animals, if applicable)
f. Confirm that you will use sterile surgical gloves (if not, provide the rationale) and a face
mask. Note other items as required for your surgeries (e.g., sterile surgical gown, etc.)
g. Supportive care during procedure (e.g., IV fluids if needed)
h. Duration of procedure
i. Post-surgical monitoring protocol during recovery period (provide continued monitoring
protocol under #17 below)
j. Time point for suture/staple/clip removal (explanation required, if greater than 14 days)
k. Deficits expected as a result of the surgery
l. For multiple survival surgeries on a single animal provide (1) scientific justification and
(2) length of time between surgeries. Provide the information on sets of surgeries an
animal might have in the following table. Add additional tables as necessary.
Name of surgery:
Name of surgery:
Continue listing addition
surgeries as necessary:
Time between Surgery 1 and 2:
Time between Surgery 2 and 3:
Continue with time between
additional surgeries:
Rationale for multiple surgical
sessions in a single animal:
University of Washington
Institutional Animal Care and Use Committee
#
Yes
PRF-16
No
17.
Potentially painful procedure - applicable for all procedures/use that would be
considered painful in the absence of anesthesia or analgesia (e.g., terminal or survival
surgery, induction of illness, etc.)
a. Monitoring protocol, including frequency, duration & specific behavioral and clinical
signs being monitored
b. Planned analgesic(s)
c. Analgesic dose
d. Volume (required for rodents only):
e. Route of administration
f. Frequency of administration
g. Scientific justification if analgesics are to be withheld from animals with signs of pain
18.
Capture/Trapping (Note: obtaining required permits is the responsibility of the PI and
is required prior to start of project)
a. Capture/Trapping protocol
b. Duration animals will be in traps or restrained
c. Indicate non-target species that may be inadvertently captured
d. Disposition of animals (e.g., euthanized, released, etc.)
19.
Special diet (e.g., high fat, etc.)
a. Composition of diet
b. Amount
c. Duration
d. Intended effects and potential side effects on animals (e.g., anticipated % weight loss or
gain, dehydration, etc.)
20.
Food/Water restriction of 12 hours or more
a. Indicate what is restricted and duration of restriction
b. Anticipated side effects (e.g., anticipated % weight loss, dehydration, etc.)
c. What parameters will be monitored, and how often will animals be monitored for health
and well-being
d. Scientific justification for restriction
e. Scientific justification for weight losses greater than 20% of baseline (or controls)
21.
Behavioral testing:
a. Describe testing procedures (including stimuli and restraint)
b. Scientific justification for use of noxious stimuli
University of Washington
Institutional Animal Care and Use Committee
#
22.
Yes
PRF-17
No
Genetically manipulated animal use or production
The following situations require approval from the Institutional Biosafety Committee (IBC).
i) Animals other than rodents: Production/use of genetically manipulated animals (e.g. fish)
ii) Rodents: Breeding experiments involving genetically manipulated rodents that contain more
than 50% of the genome of an exogenous eukaryotic virus from a single family OR breeding
experiments in which the genetically manipulated rodent’s transgene is under the control of a
gammaretroviral long terminal repeat (LTR) OR breeding experiments in which the genetically
manipulated rodent’s transgene encodes for the secretion of a toxin with an LD50 of <100
ng/kg.
If “yes” to i or ii above, submit the IBC Biological Use Authorization (BUA) Application or
IBC Request for a Change to Biological Use Authorization (BUA) form to initiate the approval
process: http://www.ehs.washington.edu/rbsresplan/bua.shtm.
a. Based on the above, is IBC Approval required?
b. Method of production (e.g., embryo transfer, superovulation procedures, breeding, etc.)
c. Method/protocol for genetic verification (e.g., age, amount of tissue, use of anesthetics,
etc.)
d. Anticipated effects of genetic manipulation (e.g., spontaneous death, tumors, etc.)
e. Method and frequency of monitoring health and well-being
f. Disposition of non-genetically manipulated animals (e.g., use as controls, euthanasia,
etc.)
23.
Breeding colony that will supply other protocols or research projects
a. Breeding method (e.g., pair, harem)
b. Protocol (e.g., randomizing procedures, breeder culling criteria, etc.)
c. For inbred, specify # of generations from source
d. For outbred stocks, specify method to ensure lack of inbreeding
e. Any other quality control procedures
f. For inbred strains, provide a description of record systems and documentation of animal
pedigrees, production and disposition
24.
Will some animals live out their normal life spans as a part of this project?
a. Indicate usage of these animals (e.g., breeders, blood donors, experimental animals)
25.
Spontaneous death of animal as an experimental endpoint, instead of euthanasia (e.g.,
toxicity studies, LD50 studies, etc.)
a. Written scientific justification (required), including the reason(s) euthanasia is not
possible
b. Monitoring protocol
University of Washington
Institutional Animal Care and Use Committee
#
Yes
PRF-18
No
26.
Non-physical Euthanasia such as CO2 or drug overdose (answer for each animal species)
a. Agent (drug, dose, route) for non-physical method
b. Criteria used to decide upon euthanasia (e.g., tissue harvest, end of study, etc.).
c. For studies in which animals may become ill, indicate the specific behavioral and clinical
signs that will be used as criteria for euthanasia.
d. Scientific justification for methods not approved by the AVMA Guidelines on Euthanasia
(2007) http://www.avma.org/issues/animal_welfare/euthanasia.pdf
27.
Physical Euthanasia on anesthetized or awake animals (answer for each animal species)
a. Method (e.g., cervical dislocation, decapitation, etc.)
b. Will the animal be anesthetized prior to physical euthanasia? If “yes”, indicate what
anesthetic will be used and make sure to include it in item #1 as well.
c. As per AVMA Panel on Euthanasia recommendation, scientific justification is required
d. Personnel performing procedures must be certified (personnel can be certified during
AUT labs or contact auts@u.washington.edu to make arrangements)
1. List personnel
2. Date of certification
e. Criteria used to decide upon euthanasia (e.g., tissue harvest, end of study, etc.)
f. For studies in which animals may become ill, indicate the specific behavioral and clinical
signs that will be used as criteria for euthanasia.
28.
Collection of tissues
a. Time point for collection
b. Tissue(s) to be collected
29.
Other procedures. NOTE: Please think through your planned studies and describe
any live animal procedures you have not already described elsewhere on this form.
30.
Training/Practice Procedures. Will you be using animals in order to train personnel or
practice procedures that are included in this protocol? If so, you must include these animals
in sections C, H and N of this form.
31.
Are there any medications or procedures which should not be administered by
veterinary personnel because they would render the results of the study invalid. Please
list them.
32.
Does this study involve use of non-human primates?
NOTE: A new Environmental Enhancement Checksheet is required for each new IACUC
protocol and each 3-year renewal. The Checksheet is located on the IACUC forms page
("Nonhuman Primate Environmental Enhancement Checksheet"). Please complete the form and
attach it to your new protocol or 3-year renewal for review. If you are having problems
accessing or filling out the form, email pwb@wanprc.org.
Note that the IACUC cannot review the protocol without the EEPL form.