Eastern Kentucky University
IACUC SOP Number: _______________
Animal Care and Use Application for Instruction
I. ADMINISTRATIVE DATA
Type of Application:
Purpose:
New
Renewal of previously approved Course/SOP number:
Instruction
Departmental Course # and Course Title:
Duration of Course:
through
Principal Faculty Instructor:
Name:
Department:
Mailing Address:
Telephone Number:
Email Address:
Co-Instructor or TA
Name:
Department:
Mailing Address:
Telephone Number:
Email Address:
Other Instructors/Personnel
Identify all individuals who will be involved in this course (i.e., co-investigators, student teaching assistants). Attach additional pages
if needed.
Name:
Rank/Title:
Responsibility in Course:
Name:
Rank/Title:
Responsibility in Course:
As Principal Course Instructor, I hereby assure that:
Regulations: I am familiar with The Guide for the Care and Use Laboratory Animals and agree to abide by the guidelines established
therein in the conduct of this project. (As appropriate and approved by the IACUC, the Guide for the Care and Use of Agricultural
Animals in Agricultural Research and Teaching, or appropriate guides for amphibians, reptiles and avians, may be used.)
Animal Use: The animals authorized for use in this course will be used only in the activities and in the manner described herein,
unless a deviation is specifically approved in advance by the IACUC.
Alternatives/Duplication: I have made a reasonable, good faith effort to find and utilize alternatives and refinements to these
procedures and to, unwarranted animal use, and unnecessary painful procedures.
Training: I verify that all personnel involved in the instructional component of this course, have completed an educational program
on the proper care and use of animals (i.e., the CITI Lab Animal Welfare Course). A copy of each individual’s certificate is attached.
I further certify that I have an appropriate background in the biology, handling, and care of the species used in this course and will
provide all personnel with training and supervision as appropriate for this course. I agree to maintain, and ensure the project
personnel maintain, current training and furnish documentation to the IACUC in a timely manner.
Permits/Licenses: I verify that I have obtained all appropriate permits and licenses to conduct the activities described in this
protocol. Copies of relevant documents are attached. I agree to maintain current permits and licenses as applicable throughout
the approval period of this course and furnish up-to-date documentation to the IACUC in a timely manner.
Access to Animals: I understand that any member of the IACUC, including the attending veterinarian, may enter the premises
where these animals will be used or housed at any time for the performance of official duties.
Principal Investigator
Date
Faculty Advisor, if applicable
Date
As Department Chair, I hereby acknowledge receipt and review of this protocol and approve its submission to the IACUC
Department Chair
Date
____________________________________________________________________________________________________
Please submit one original of all application materials to Sponsored Programs, Jones 414, Coates CPO 20
II. ANIMAL USE SUMMARY-Standard Operating Procedure for this Course
In layman’s language, briefly describe the primary aims of the course as they relate to animal use, and the procedures to which the animals will be
subjected. Please describe the following components of the course in the space provided on this page.
List species selected to be used in course. If identifying specific species is not applicable, identifying a group is acceptable: (For example, if
teaching techniques for field trapping of small mammals, but knowing ahead of time which species you will capture is impossible, you may simply
state small mammals)
Rational for species selected and species use based on Learning Goal(s) of Course: (For example: to instruct wildlife students in field
sampling methods for small mammal populations)
Animal use procedures for this course: (For example: a pit trap array will be set to survey small mammals; pit traps will have drainage and thus
be non-lethal; the instructor will show students how to collect field data on captured animals and safe release)
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III. ESTIMATED NUMBER OF ANIMALS
Animal Common Name
Source
(i.e., vendor)
Total # Animals
to be Used
Pain
Level*
Pain Drugs Used
Will Animals
Survive?
Yes
No
Yes
No
Yes
No
Yes
No
*Use appropriate letter to indicate maximum pain level/discomfort/distress to be experienced by animals:
USDA Category B
USDA Category C
USDA Category D
USDA Category E
Breeding or Holding Colony
No more than momentary or
Pain or distress appropriately
Pain or distress or potential pain
Protocols
slight pain or distress and no use
relieved with anesthetics,
or distress that is not relieved
of pain-relieving drugs, or no
analgesics and/or tranquilizer
with anesthetics, analgesics
pain or distress.
drugs or other methods for
and/or tranquilizer drugs or
relieving pain or distress.
other methods for relieving pain
or distress.
For pain level E: As evidence of your assurance that you have considered alternatives for procedures that may cause more than momentary or
slight pain or distress, please provide a short narrative description of the methods and sources (e.g., Animal Welfare Information Center) used in
making this determination.
IV. PROCEDURES CHECKLIST
1. Pain: If pain is involved, what criteria will be used to assess pain/discomfort?
Loss of appetite
Guarding (protecting the painful area)
Loss of weight
Licking, biting, scratching, or shaking a particular area
Loss of mobility
Failure to groom, causing an unkempt appearance
Vocalizing
Failure to show normal patterns of inquisitiveness
Restlessness
Abnormal resting postures in which the animal appears to be sleeping or is hunched up
Other:
2. Drug Use: If drugs are used to minimize pain/discomfort, please list below.
Species
Drug
Dose
Route
Frequency
Will Drug Enforcement Agency (DEA) controlled substances be used?
Yes
No
If yes, list substances below and attach copies of DEA permit(s) for substance(s).
3. Animal Holding Timeline: Will animals be held in a study area outside the animal facility for more than 12 hours?
Yes
No
If yes, identify where and describe under what conditions the animal(s) will be held. Be specific and describe care that will be provided to the
animals. You may use any potentially pre-existing SOP’s that your department has on hand for the animals in question.
4. Human Medical Risks and Precautions: Provide a description of the medical risks that may be present for individuals involved in this
Course (i.e., rabies, allergies, etc.)
Describe medical precautions that have been taken to protect the teaching personnel involved in the project (e.g., pre-rabies exposure
immunization, tetanus immunization, etc.).
5. Special Concerns: Please indicate whether your project includes any of the following.
Blood and/or tissue collection
Nutritional studies
Behavioral studies
Sedatives
Use of immobilizing agents or muscle relaxants without anesthesia
Antibody production and collection
Surgery (Attach Form S)
Euthanasia (Attach Form E)
Physical Restraint or Induction of Stress (Attach Form P)
Potentially Hazardous Materials (Attach Form H)
V. APPLICATION CHECKLIST
*Animal Care and Use Application Form with original signatures
*Verification of Training for all Personnel
*Form W: Animal Worker Questionnaire for all personnel
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*Form E: Fate of Animals at End of Course or Study
Form H if project involves potentially hazardous materials
Form P if project involves physical restraint or induction of stress
Form S if project involves surgical procedures
Letter of approval if animals are to be housed in the Biological Sciences animal facility
Collecting permit(s) if applicable
DEA permit(s) if applicable
*Required for all applications
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