variation form - University of New England

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Animal Ethics Committee
Ethics Variation for Research Involving Animals
~ VARIATION FORM ~
NOTES:

What is a variation?
A variation is any change made to your originally approved research protocol. Variations may
include, but are not limited to, extensions of time, changes of titles, additions to the research, or
changes to researchers
Variations must be approved by the AEC before they are implemented.

When you should use this form.
For requesting approval for a proposed variation to your original research project which has
previously been approved by the University of New England’s Animal Ethics Committee (AEC).

Care should be taken in the preparation of the variation, ensuring that you answer all questions
relevant to your application to vary the existing, approved protocol.

Answers to questions must be:

Entered into the spaces provided – these can be expanded if you require more
room, although answers should be kept as concise as possible while at the same
time providing the required detail.

All answers must be typed using a font size no smaller than Georgia 10pt or similar.
Submission:
Variation forms should be submitted to the address below by the closing date of the next meeting. It is
advised that you retain a copy for your files.
Research Ethics Officer
Research Services
T.C Lamble Building
The University of England
Armidale NSW 2351
02 6773 3449
02 6773 3543
[email protected]
PLEASE DO NOT SUBMIT THIS PAGE WITH YOUR VARIATION
13/10/2015
Animal Ethics Committee
Ethics Variation for Research Involving Animals
~ VARIATION FORM ~
Variation Request for an Extension /Amendment/Variation or Addition/Deletion of
Staff/Students to an already, approved protocol
Authority Number: AEC
Project Title:
Principal Investigator:
1.
2.
13/10/2015
Type of Variation Requested
Time Extension
Extra Animals
Adding New Personnel
Removing Personnel
Changing Procedure
Other
Provide details of the variation including justification as to why it is necessary to the
approved protocol.
3.
Nature of Procedural Modification. Please provide both the question number on the
original application that the change relates to as well and the original wording on the
question.
Question
No.
Previous submission wording
Proposed amendment
4.
If the previously indicated end date needs extending, please indicate the new end date
and why the project has been prolonged.
5a.
If changes to animal numbers are required, detail the number of each strain or species
of animals originally approved.
Species No. Strain
5b.
Common Name
Purpose
Procedure Total
List the requested number of each strain or species of animals now needed.
Species No. Strain
13/10/2015
Total
List the number of each strain or species of animals used to date.
Species No. Strain
5c.
Common Name
Common Name
Purpose
Procedure Total
6.
Provide details of any additional personnel to be listed on the protocol:
Name (eg Mr Bill Dawson)
UNE Staff/Student Number
Animal Ethics Course Number
Qualifications
School/Employer
Mailing address
Work Phone No.
After Hours Phone No.
Email Address
Experience relevant to this
project
Copy this table and repeat for any additional personnel.
Specify for each person added above their level of experience with the procedures and
animals being used in this protocol if they have no experience, describe how the
relevant experience will be obtained.
a) Have any of the nominated researchers ever had a research authority cancelled?
No
Yes
If yes, please state which researchers.
b) Have all the nominated researchers completed an Animal Ethics course or similar
Yes
No
training?
If no, please state which researchers have not.
The researchers are reminded that this course must be completed before the
research begins.
13/10/2015
7.
Deletion of personnel listed on the approved protocol:
List all personnel to be removed from the protocol
8.
Does this request involve changes to the location
Yes
No
If ‘Yes’ please provide details and justification.
If ‘Yes’ have you confirmed with the facility Manager that the facility is available
No
Yes
(Please do not submit this request until you have received this confirmation).
9.
Other changes not specified above. Provide details and justification.
10.
Do any of these changes involve/introduce the use of genetically modified organisms?
No
Yes
If ‘Yes’ please provide details
13/10/2015
11.
Will this change/alter the risks or ethical issues associated with the study?
Yes
No
Yes
No
Yes
No
If ‘Yes’ please provide details.
12.
Will this alter the benefits associated with the study?
If ‘Yes’ please provide details.
13.
Will this variation require permissions or approvals from other authorities?
If ‘Yes’ please provide details.
Declaration
In signing this variation request I/we declare that I/we have read the application and approval
notice for the approved protocol, agree to abide by the requirements of the Declaration of
Responsibility and that the variation will not be implemented until approval has been received from
the AEC.
Print Name
Principal
Investigator
Associate(s):
13/10/2015
Signature
Date
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