APPLICATION FOR
APPROVAL TO USE VERTEBRATE ANIMALS IN RESEARCH
General Information and Instruction
1. For all applications, complete each section of the
questionnaire. Mark those sections, which are not applicable
“N/A” (particularly Sections X and XI). A signed Applicant
certification page must be returned with the completed
application.
2. Every new application and every third-year renewal must be
accompanied by the methods and procedures section of the
proposal.
3. Submit the original of the completed application to Sue
Shingle, Office of the Associate Provost, Warner Hall, 405.
Any questions regarding the proper procedures for
completing the questionnaire should be directed to Carl
Olson, Chair of the Institutional Animal Care and Use
Committee (IACUC), x8-3968. Applications will be returned if
incomplete or illegible.
4. If consultation with a veterinarian is necessary, please contact
Dr. Paul Bramson, our consulting veterinarian before the
application is completed. Dr. Bramson’s telephone number is
383-2009.
5. It is not within the charge of the IACUC to perform scientific
review. However, the committee may exercise its option to
request ad hoc scientific review of any application for which it
is deemed necessary.
1
APPLICATION FOR APPROVAL TO USE VERTEBRATE ANIMALS
IN RESEARCH
Institutional Animal Care and Use Committee (IACUC)
Carnegie Mellon University
Associate Provost Office
Warner Hall, Room 405
I. PRINCIPAL INVESTIGATOR
Faculty Title:
Mailing Address:
Email:
Department:
Work Phone:
II. TITLE OF PROJECT
Type of Application:
New
Renewal
Source of Funding:
Revision
Submission Date:
If this is a renewal or revision, have any changes been made in the sections
of the proposal utilizing animals?
Yes
No
If yes, please summarize
If no, provide original approval date
III. ANIMAL USAGE (ALL SPECIES OF ANIMALS USED IN THE STUDY MUST
BE INDICATED IN THE PROTOCOL)
A. ANIMAL CLASSIFICATION
Species
Species
Species
Species
Strain
Strain
Strain
Strain
Total Number/Year
Total Number/Year
Total Number/Year
Total Number/Year
2
Where will animals be housed?
Building
Room(s)
Who provides animal care on weekdays?
On weekends and holidays?
B. ANIMAL CARE DAYS
Number of animals/year
Time being held (days)
x
x
x
x
x
Animals care days/year
=
=
=
=
=
C. SOURCE OR VENDOR OF ANIMAL SPECIES USED
D. Will your source or vendor provide documentation that your animals are free from
infectious agents?
Yes
No
Documentation of non-infectious status of animals must be provided if they are to be
housed in a facility shared by other investigators.
E. Are any animals to be used for breeding purposes?
If yes, please specify reason.
Yes
IV. ALTERNATIVES TO THE USE OF ANIMALS
Is there any alternative to the use of live animals for this project?
Yes
No
Could a phylogenetically lower species be used?
Yes
No
What requirements necessitate the use of the species proposed in this project?
3
No
V. HAZARDOUS AGENT INFORMATION
A. Will radioactive substances be administered in intact animals?
Yes
No
If yes, list isotopes and amounts administered.
B. Will hazardous biological agents or recombinant DNA technology be used in
intact animals?
Yes
No
If yes, list agent(s) and classification.
C. Will regulated toxic chemicals or carcinogens be used in animals that are going to
be returned to the housing facility? Include copy of MSDS (Material Safety Data
Sheet).
Yes
No
If yes, list agents.
VI. EXPERIMENTAL MANIPULATIONS
A. What is the experimental treatment of the animals? (Do not respond to this
question by answering “SEE ATTACHED PROTOCOL”).
4
B. How many animals per experimental group?
How was this number selected?
Can the number of animals per experimental group be reduced?
Yes
No
C. Will food be removed prior to an experiment?
Yes
No
How long?
Justify if longer than 24 hours.
D. Will water be removed prior to an experiment?
Yes
No
How long?
Justify if longer than 12 hours.
E. Will animals be anesthetized? (Give regimen used for each species.)
Yes
No
If yes, list drug(s).
Dose.
Route of administration.
Will unanesthetized animals be subjected to painful and/or stressful procedures
during the experiment?
Yes
No
(If pain or distress cannot be alleviated, written justification including references must
accompany this submittal.)
How will pain or distress be assessed?
5
Will tranquilizers or analgesics be administered?
If yes, list agent.
Dose.
Route of administration.
Yes
No
F. Will any form of external stimulation creating distress (e.g., hot-plate, foot shock)
be used?
Yes
No
Explain:
G. Will surgery be performed?
Yes
No
Multiple survival surgeries? (A yes response to this question requires written
justification as an addendum. See policy handbook.)
Yes
No
H. Will physical restraint be necessary in unanesthetized animals?
Yes
No
Describe the restraint device.
Justify the use of restraint.
How often will animals be restrained?
Duration of restraint.
How are animals acclimated to the restraint device?
I. Will chemical adjuvants be used? (See policy handbook.)
Type:
Site(s) and frequency of administration.
6
Yes
No
VII. POST OPERATIVE CARE
A. In the post-operative period, will analgesics, antibiotics, or similar compounds be
administered?
Yes
No
List agent(s).
Dose.
Route of administration.
Duration of treatment.
Who will monitor recovery from anesthesia?
Who will assess general progress and return to functionality?
What methods will be used to assess functionality?
VIII. EXPERIMENTAL ENDPOINT
Is survival time a necessary experimental variable to be measured? (e.g., Will the
animals die as a direct result of the experimental treatment?) (Not euthanasia.)
Yes
No
(A yes response to this question requires written justification as an addendum. See
policy handbook.)
IX. EUTHANASIA
Will animals be euthanized?
Method.
Yes
If drug is used, provide dose.
Route of administration.
If no, what is final disposition of animals?
7
No
X. ALTERNATIVES TO PROPOSED PROCEDURES
The Animal Welfare Act (Public Law 99-158, August, 1989) requires that all
investigators using warm-blooded species other than rats, mice or birds consider
“alternatives to procedures that cause more than momentary or slight pain or distress
to the animals,” regardless of whether pain and/or distress is alleviated by
tranquilizers, analgesics and/or anesthetics. If applicable, investigators must append
“a written narrative description of the methods and sources, e.g., the Animal Welfare
Information Center, used to determine that alternatives [to the proposed experimental
procedures are] not available.” (see Policy Handbook)
XI. UNNECESSARY DUPLICATION OF PREVIOUS STUDIES:
The Animal Welfare Act (Public Law 99-158, August, 1989) requires that all
investigators using warm-blooded species other than rats, mice or birds provide
“written assurance that the proposed experiments do not unnecessarily duplicate
previous experiments.” In planning your study, what procedures did you follow to
determine that the proposed experiments are not unnecessarily duplicative. Append
your narrative, including the list of supporting references.
8
APPLICANT’S CERTIFICATION
1.
I agree to abide by all Carnegie Mellon University policies and procedures
regulating the use of vertebrate animals in research; by the provisions of the
NIH Guide for the Care and Use of Laboratory Animals; and by all other
applicable laws, policies, and regulations governing the use of animals in
research.
2.
I declare that all experiments involving live animals will be performed under my
supervision. All participants are qualified and have been trained in proper
procedures using animals, including handling, administration of anesthetics,
surgery, post-procedural management, and the analgesics and euthanasia to
be used in this project.
3.
I certify that this application accurately reflects all procedures involving animal
subjects described in the proposal submitted for the support of this project.
Any proposed revision to or variation from this application as approved will be
promptly forwarded to the Animal Care and Use Committee for review and
approval.
4.
I understand that if I cannot be contacted in the event that animals in this
project show evidence of illness or pain, emergency care will be administered
at the discretion of the Animal Care Facility veterinary staff.
Signature of Principal Investigator
Date
FOR COMMITTEE USE ONLY
Date
Approve
Committee Member
Disapprove
Defer decision until committee meeting
Comments:
9