VICTORIAUNIVERSITY
ANIMAL EXPERIMENTATION ETHICS COMMITTEE
Applicationfor Approvalof a Research/Teaching Project Involvingthe UseofAnimals
(This form is available in electronic format via the Office for Research Homepage at the following address )
Notes:1.The Australian Code of Practice for the Care and Use of Animals for Scientific Purpose defines animal as any live non-human vertebrate.
2.Applications must be typed.
3.Applications will be included in the University Register of Animal
Experimentation. Any information of a commercial or patentable nature should
be forwarded separately and marked 'confidential'.
4.Avoid the use of scientific terms.
5.If an institution other than VictoriaUniversity is to be involved in the project, or
the project is part of another approved project, please provide with this
application, evidence of ethics approval from the other institution.
- Forward original application to Ms Pushpa Richards, Secretary, AEEC in the
Office for Research, 6 Geelong Road, FootscrayPark Campus.
1.PROJECT TITLE:
2.CHIEF INVESTIGATOR/LECTURER IN CHARGE:
3.DEPARTMENT and CAMPUS:
4.PROPOSED TIME PERIOD FOR PROJECT:
(Note: Time period must not exceed three years and is subject to annual review.)
STARTING DATE://
TERMINATION DATE://
Office Use OnlyAEETH Application Registration Number
AEEC Committee Paper Number
- JUSTIFICATION OF PROJECT
Teaching / Research
COURSE/SUBJECT(where applicable):
5.1 Describe in lay terms the scientific or educational aims of this project.
5.2 Has this experiment been conducted before, in your laboratories or elsewhere?
Yes / NoIf yes, explain why it needs to be repeated and explain how it relates to any previous studies. (Not required for Teaching Projects).
5.3 Please detail what methods other than the use of animals have been considered, and why animals or animal tissue must be used rather than alternative techniques:
5.4Please detail any feature of the proposal which raises special ethical considerations.
5.5Please justify the project in accordance with in relation to the possible outcomes described in section 2.2.11 (v) of 'The Code'.
6.EXPERIMENTAL PROCEDURES
6.1In LAY LANGUAGE, describe the methodology, giving a clear, step by step description of all procedures to be carried out on each group of animals (including controls), from the beginning to the end of the experiment. Technical details may omitted here if they are clearly described in sections 6.3 or 6.4 or 6.5
6.2CLASSIFICATION OF PROJECT. Please circle the appropriate letter(s).
AProjects requiring animals to be killed for the preparation of
whole animal or tissue specimens.
BProcedures carried out under anaesthesia and the animal
killed without regaining consciousness.
CProcedures carried out under anaesthesia and requiring
recovery of animals for subsequent investigations.
DPurely breeding project.
EProduction of antisera.
FField work.
GObservations of intact animals.
HDissection of dead animals.
IUse of animal tissue
JOther - please specify.
6.3Are any surgical procedures to be carried out?
Yes / NoIf yes, please specify:
Anaesthetic agent:Dose rate:
Route of Administration:Duration:
Monitoring (including Post-operative):
Observations to be made to ensure anaesthesia is adequate:
Are neuromuscular blocking agents to be used?
Yes / NoIf yes specify
Agent:Dose rate:
Route of Administration:Duration:
Why do neuromuscular blockers need to be used?
What observations will be made to ensure that the animal is
insensitive to pain?
Give full details of all surgical procedures to be carried out, including
post operative procedures and monitoring:
6.4Will blood or tissue be sampled?
Yes / NoIf yes, give details of sampling methods:
Body weight of animal / Sample / Volume of sample / Frequency of sampling / Site of sampling6.5Will any drugs, chemical compounds or biological agents be
administered?
Yes / NoIf yes, give full details in the table:
Body weight / Name of Compound / Method and route of administration / Dose per Kg / FrequencyDetail any known or anticipated effects of the compound(s) to be
administered:
6.6Please detail the anticipated degree, duration and extent of pain or distress and any consequent suffering. Note that a row should be completed for each invasive procedure (including pithing) and any other procedure likely to cause pain or distress
Procedure / Level of Pain and DistressPAIN / DISTRESS
Intensity
(none to severe) / Duration
(sec- days) / Intensity
(none to severe) / Duration
(sec- days)
6.7Detail what steps are to be taken to reduce/minimise/eliminate and to monitor any pain and suffering. Studies of pain and suffering per se must be justifiable necessary and reasonable. If analgesics are to be used, provide full details:
The monitoring of animals must be at all times adequate to prevent the occurrence, or allow prompt alleviation of pain or distress.
Section 2.2.11 (xiii) of 'the Code' states that procedures which may cause pain and distress but in which anaesthesia and analgesia cannot be used must be justified in detail. The planned end-point and the reasons for its choice should be provided. Death should not be used as an end-point.
7.ANIMALS:
7.1Please give details on the following for animals used, dead or alive, or animal tissue used:
SPECIES / COMMON NAME / SOURCE / NUMBER/WEIGHT REQUIRED7.2Provide details of statistical justification for number of animals to be used.
7.3Have these animals previously been used in any experiment?
Yes / NoIf yes, provide justification for their re-use. Include information describing the previous use of these animals and the level of pain or discomfort expected in the current proposal.
7.4If animals, dead or alive, are to be transported for this experiment, please detail arrangements made for transport:
7.5If protected native species, provide details of appropriate permit held:
Holder:
Issuing Agency:Serial No:
Date of Issue:Period of Validity:
If appropriate permit is not held, please detail action taken to obtain one:
7.6Housing conditions:
Type of Caging:
Number of Animals per Cage:
Bedding Material:
TemperatureRange of Room:
Provide details of facilities for exercise or activity for the animals
7.7Location of animals for duration of project, please specify:
H - Held
E – Experimentation
T – Tissue Only
FootscrayPark Campus / Werribee Campus / St Albans CampusG105 / S101 / 6.627
G608 / S102 / 6.129
G609A / B54 / 6.128
G609 / Animal House Compound / 6.227
ARC for Grasslands, portable near the tennis courts
Other, please specify and complete a Field Work Notification Form:
Room Number:
Campus:
Provide relevant details if experimentation is to be carried out as
fieldwork or off-campus collaborative project:
7.8In cases of experiments on living animals, how will the wellbeing of the animals be monitored, and how frequently:
(Note: supervision is expected to continue on non-working days.)
Hourly:
Daily:
Every Second Day:
Other - Please specify:
What is the longest period the animals will be left unchecked (including weekends and public holidays)?
7.9Who is the supervisor directly involved with the animals:
NamePosition/Role
______
7.10Completion of Project:
(a)If animals are to be killed state:
(i) The method to be used:
(ii) The method of disposal:
(b)Why is destruction of animal(s) necessary?
(c)If animals are not killed, what happens to them?
(d)If a dead animal or dead tissue, is to be used, give details of the procedure for disposal of carcass and waste.
(Note: The Code (Section 1.17) requires that an animal which develops signs of pain or distress of a kind and degree not predicted in the proposal, must have the pain or distress alleviated promptly. If severe pain cannot be alleviated without delay, the animal must be killed humanely forthwith. Alleviation of such pain or distress must take precedence over finishing an experiment.)
7.11Detail any possible health risks to other animals or staff.
(Section 2.2.9 (xxi) of the Code refers)
7.12Are Genetically Modified mice/rats being used in this experiment?
Yes / NoIfyes, provide evidence of approval from the VU Institutional Biosafety Committee ((IBC). Please refer to the IBC website at the following link for approval process:
8.PERSONNEL AND EXPERTISE
It is an offence in Victoria for a person to undertake a scientific procedure on an animal without approval from the relevant Animal Experimentation Ethics Committee
8.1Chief investigator:
Qualifications:
Telephone:
Nominee when Absent:
Qualifications:
Telephone:
Department:
8.2Identify all other personnel involved in project
(include co-investigators, research students, technicians and any others who will be handling the animals)
Name / Qualifications / Position in Department (lecturer, Ph.D student etc) / Previous Experience / Training Required8.3Indicate that appropriate expertise exists to satisfactorily complete the project with particular reference to those procedures involving animals. Indicate the role of all personnel involved in the project, and how the chief investigator considers them to be suitable for that role.
8.4 What training will be given to co-investigators, research students, technicians or others who will be dealing with the animals, if they do not have appropriate experience?
9DATA RETENTION
9.1Indicate the period for which the data for the project will be held. (Please refer to the University's Code of Conduct for Research,Section 3.1.2)
10 PUBLICATION OF FINDINGS
10.1Where do you propose to publish or otherwise use the results of this project (Research Projects only)?
11.DECLARATIONS:
11.1Declaration
We, the undersigned, are familiar with, and have access to copies of, the Prevention of Cruelty to Animals Act, (1986), and Amendment 1994 made under the authority of this Act and the current NHMRC/CSIRO/AAC 'Australian Code of practice for the care and use of animals for scientific purposes'. We declare that this study has been designed for the most effective scientific use of the fewest animals. We accept responsibility for the conduct of the experimental procedures in accordance with the Code and any other conditions specified by the University AEEC.
Chief Investigator/Lecturer in Charge, signature:
______Date: ______
Signature(s) of all other personnel involved in project
(a)______Date:______
(b)______Date:______
(c)______Date:______
11.2Certification
I certify that:
(a) the use of animals is justified,
(b) animals are available and in good health,
(c) suitable accommodation is available,
(d) adequate instructions have been provided for:
(i) routine animal care;
(ii) post-operative care and monitoring (if necessary);
(iii) emergencies, and
(e) persons are competent to undertake the tasks described.
Head of Department:______Date:______
Please note: An Annual Report is to be completed, and forwarded to the Secretary, University AEEC by 31 December (unless otherwise approved) each year, or within 30 days of the conclusion of the project.
DECLARATION BY CHAIRPERSON OF THE AEEC
I certify that this project, as submitted to the AEEC has been considered and approved by the AEEC.
______
(Chairperson)(Date)