Institutional Animal Care and Use Committee (IACUC) UM
For Office Use Only:
Registration no:
Date received:
The Leader In Research and Innovation
UNIVERSITY OF MALAYA
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
Animal Research Protocol Application (ARPA) Form
Please type clearly and return the completed form to:
Dr. Haji Azizuddin bin Haji Kamaruddin
Secretary
Institutional Animal Care and Use Committee (IACUC)
University of Malaya
(Attn: Puan Bibi Shaswani)
c/o Neuroscience Lab
Institute of Biological Sciences
Faculty of Science
University of Malaya
Phone no.
: 03-7967 4213
Email
: um.iacuc@um.edu.my
General Information
1. Applicant
Applicant (Researcher)
Principal investigator
(if different from Applicant)
Name :
Matrics no :
Academic title :
Department :
Faculty :
Phone no. :
Mobile phone no. :
Fax no. :
Email address :
For postgraduate students:
Masters
(Specify)______________
Supervisor _____________________________
For Teaching applications :
PhD
Phone/ Mobile no. ___________
Course Coordinator ______________________________
Course (Specify) _______________________________
ARPA IACUC form/ 2014version5
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Institutional Animal Care and Use Committee (IACUC) UM
2. Associate investigator(s)
[List the names of all other individuals (besides the applicant) authorized to conduct procedures
involving animals under this proposal]
Name
Department
Position title
E-mail
Phone/ Mobile
(Lecturer,
Postgrads, RA,
Undergrads, Staff)
3. Type of application
First submission
Resubmission
Amendment (Existing Ethic no.: _______________________)
4. Source of funding
Grant type :
HIR/ PPP/ FRGS/ Science Fund/ Techno Fund/ UMRG*
Others :
Grant no. :
Grant expiry date :
* Please delete where appropriate
5. Proposed length of study using animals
Start date:
End date:
Note: Approval of ARPA forms require 2-3 months processing time.
6. Competency in Laboratory Animal Science
Have attended such course/ workshop. (Specify) ____________________________
Have not attended course but willing if its available
Have experience/ expertise. (Specify)______________________________________
ARPA IACUC form/ 2014version5
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Institutional Animal Care and Use Committee (IACUC) UM
Animal Species/Strains
No
Species
Strain
Age
Sex
Weight
Qty
Source
1
2
3
Animal is to be carried in secured cages and covered
Transportation involved. Please specify __________________________________________
Categories Of Biomedical Experiments Based On
Increasing Ethical Concerns For Animals
Please refer to Appendix A
A
B
C
D
E
Outlines of Animal Use
Will the animal be kept in the Animal Experimental Cabins, Laboratory Animal Centre?
Yes

Duration the animal will be kept in the Animal Experimental Cabins

Any special care required for the animals?
No
Please specify the location of the Animal Holding Facility
Requirement of 2 weeks Quarantine/ Isolation Rule
Title Of Project
ARPA IACUC form/ 2014version5
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Institutional Animal Care and Use Committee (IACUC) UM
Rationale For Animals Use
1. Explain the rationale for animal use [Include reasons why non-animal models are not used] :
2. Justify the appropriateness of species selected [The species selected should be the lowest
possible on the phylogenetic scale] :
3. Provide animal references [Cite THREE recent relevant references] :
Background And Justification
1. What is already known about the research topic?
2. Justification for this study [What this study adds to the body of knowledge] :
ARPA IACUC form/ 2014version5
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Institutional Animal Care and Use Committee (IACUC) UM
Study Objectives
1. General:
2. Specific:
Experimental Design
1. Experimental design to achieve study objectives [Must include flow chart or schematic
diagram wherever applicable] :
2. Sample size and its justification :
3. Statistical techniques to be employed :
Surgical Intervention and Pain Management
[Give details of the surgical procedure and the pain management during and/or after surgical
intervention in live animal studies]:
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Institutional Animal Care and Use Committee (IACUC) UM
Method Of Euthanasia and Disposal
1. Method of euthanasia [Specify how the animals are sacrificed as in sampling of organs and
tissues, or at the end of the experiments] :
2. Method of carcass disposal [Include method of disposing contaminated organs /tissues] :
Placed in plastic bags to be stored in deep freezer and disposed by the UM Registered
Bio-disposable Contractor
Other method (Specify)____________________________________________________
Safety and Health Issues
[Identify unsafe conditions and hazardous agents (biological/chemical/physical) used during the
animal study and any specific precautions to be taken by staff involved.] :
Hazards/ Unsafe condition (Specify)_____________________________________________
Wear full PPE protection and practice strict personal hygiene
Universal Precaution (UP) for Needle Stick Injury (NSI)
Up to date Immunization Programme for Tetanus, Hepatitis B, others____________________
Other safety precautions (Specify)_______________________________________________
Applicant’s signature
Supervisor’s signature and stamp
______________________
Head of Department’s signature and stamp
* delete where appropriate.
Note: If applicant is a Lecturer, the HOD’s signature is required. If applicant is a postgraduate student,
then both the supervisor and HOD signature are required.
ARPA IACUC form/ 2014version5
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Institutional Animal Care and Use Committee (IACUC) UM
________________________________________________________________________________
For Office Use
Decision of Institutional Animal Care and Use Committee (IACUC), Faculty of Medicine,
University of Malaya
APPROVED
CONDITIONAL APPROVAL PENDING CORRECTIONS
Reason(s):_________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
NOT APPROVED
Reason(s):_________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Date of Approval:
Ethic no.:
ARPA IACUC form/ 2014version5
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Institutional Animal Care and Use Committee (IACUC) UM
Appendix A
Categories Of Biomedical Experiments Based On
Increasing Ethical Concerns For Animals
(Guide for the Care and Use of Laboratory Animals.
National Research Council. National Academy Press. 1996 )
Categories
Category A
Experiments involving either no living
materials or use of no living
materials, use of plants, bacteria,
protozoa, or invertebrate animal
species
Category B
Experiments on vertebrate animal
species that are expected to produce
little or no discomfort.
Category C
Experiments that involve some minor
stress and pain to vertebrate animal
species
Category D
Experiments that involve significant
but unavoidable stress and pain to
vertebrate animal species
Category E
Procedures that involve inflicting
severe pain above the pain tolerance
threshold
of
unanesthetized,
conscious animals.
ARPA IACUC form/ 2014version5
Examples and Comments
Biochemical, botanical, bacteriological, microbiological, or invertebrate
animal studies, tissue cultures, studies on tissues obtained from
autopsy or from slaughterhouse, studies on embryonated eggs.
Mere holding of animals captive for experimental purposes, simple
procedures such as injection and blood sampling, physical
examinations, experiments on completely anesthetized animals which
do not regain consciousness, food/ water deprivation for short duration
(a few hours), standard methods of euthanasia that induce rapid
unconsciousness. Anaesthetic overdose or decapitation preceded by
sedation or light anesthesia.
Exposure of blood vessels or implantation of catheters with
anaesthesia, behavioral experiments on awake animals that involve
short-term stressful restraint, immunization employing Freund’s
adjuvant, noxious stimuli, surgical procedures under anaesthesia that
may result in minor post-surgical discomfort. Category C procedures
incur additional concern in proportion to the degree and duration of
unavoidable stress or discomfort.
Deliberate induction of behavioral stress in order to test its effect, major
surgical procedures under anaesthesia that result in significant postoperative discomfort, induction of an anatomical or physiological deficit
that will result in pain and distress, application of noxious stimuli,
prolonged periods (up to several hours) of physical restraint, maternal
deprivation with substitution of punitive surrogates, induction of
aggression, procedures that produce pain in which anaesthetics are not
used. Toxicity testing with death as end point, production of radiation
sickness, Stress and shock research that would result in pain
approaching the pain tolerance threshold. Category D experiments
present an explicit responsibility on the investigator to explore
alternative designs to ensure that animal disasters is minimized or
eliminated.
Use of muscle relaxants or paraytic drugs such as succinyl choline or
Curariform drugs used for surgical restraint without the use of
anesthetics, severe burn or trauma infliction on unanesthetized animals,
attempts to induce psychotic-like behavior, killing by use of microwave
ovens designed for domestic kitchens. Inescapable severe stress or
terminal stress. Category E experiments are considered highly
questionable or unacceptable, irrespective of the significance of
anticipated results.
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