Page 1 2018 Certification Application Questionnaire
CERTIFICATIONAPPLICATION QUESTIONNAIRE (2018 Edition)
INSTRUCTIONS ~ PLEASE READ CAREFULLY
The 2018 edition of this applicationmay only be used when submitting for deadlines occurring in the year 2018. The 2019edition will be available in October2018.
NEW IN THE LAST FIVE YEARS: Items added or revised in the last five years are as follows:2018:New: AC-20, AC-21, AC-22, AC-30, AC-31, AC-32, AC-33, AC-34, C-3, C-14, S-13, GS-17, GS-18. 2017: New: AC-28.a., AC-28.b., AC-52, AC-57.b., VC-1, VC-2, VC-3, SA-4, F-8, SS-3, SS-12,SS-18.a., SS-30, SS-31, SS-44; Revised:AC-31, AC-32, AC-55, AC-58, VC-19, C-10, SA-6. 2016:Editorial changes only. 2015:New: AC-30; Revised: AC-14, AC-51, AC-52, VC-16, PF-18, SS-17, SS-19. 2014:Revised: AC-7.
TO APPLY FOR CERTIFICATIONfacilitiesmust: (1) operate based on philosophies and practices considered by AZA as being modern best practicesof the profession, (2) meet or exceed all AZA accreditation standards and adhere to all AZA policies, and (3) meet all aspects of the definition of a certified related facility (see page 14of the 2018Edition of the “Guide to Certification of Related Facilities”).
“Appearing on VC Report form only” NOTATION: This application/questionnaire is numbered to sequentially correspond with the Visiting Committee Report Form provided to the inspection team. However, a single question appearing in this application may have several additional, related questions in the Visiting Committee Report Form for inspectors. To avoid the impression that questions in a sequence are erroneously missing from this application, those related questions for inspectorsare noted as “Appearing on Visiting Committee Report form only”.
BASIC INSTRUCTIONS: (1)The annual edition of this form must match the year in which you submit your certification materials. (2) The application and all supporting materials should be submitted in English. (3) Keep a copy of the completed application for your future reference and send five complete copies on flash driveto: Accreditation Programs, AZA, 8403 Colesville Road, Suite 710, Silver Spring, Maryland 20910. (4)Instructions in the section entitled “Assembling The Application Package” must be followed precisely (see pages 20-22 of the 2018 Edition of the “Guide to Certification of Related Facilities” booklet). Improperly assembled or incomplete applications will be returned to the applicant. Related delays could result in an inabilityto continue on the processing schedule desired by the applicant.
FLASH DRIVE: This application and its accompanying materials must be submitted on flash drive. Please see detailed instructions in the 2018Edition of the“Guide to Certification of Related Facilities”. Contact the AZA office if you have any questions about this requirement.
DEADLINES: Those desiring review at the Spring (March) meeting must submit their application materials for receipt by September 1. Those desiring review at the Fall (September) meeting must submit their application materials for receipt by March 1. Late applications will not be acceptedand will automatically be scheduled for review at the regularly scheduled meeting following the one submitted for. Missing a deadline will not be considered an acceptable reason for extension of certification, and will result in a lapse in certification and AZA membership. [NOTE: If the deadline falls on a weekend or holiday, the next regular business day immediately following shall be considered the deadline.]
FEES: Fees must be enclosed with this application as follows: $2,200 ($1,200 to cover the non-refundable* filing fee, and an additional $1,000 as a deposit towards Visiting Committee expenses). International applicants located in countries other than Canada and Mexico should enclose $3,200 ($1,200 filing fee, and a $2,000 deposit towards Visiting Committee expenses). *Filing fees are non-refundable once the official review process has started. If a facility withdraws its application before the official review has started, the fee may be refunded. Checks should be made payable to AZA. A single check is sufficient. See page 30 for more details.
*NOTATION OF STANDARDS: As applicable, the relevant standard(s) is noted immediately following the question. Please note that every question is not necessarily tied to a standard and, conversely, every standard is not necessarily represented by a question. Applicants should be well familiar with standards to ensure full compliance.
Name of Facility Applying For Certification:
Street Address:
City: State: Zip+4:
Mailing Address, if different:
Facility’s Telephone Number: Area Code + Fax Number:
Director’s Name:
Director’s Title (Director, President, etc.):
Director’s Phone # or Extension: Director’s E-mail Address:
GENERAL INFORMATION (GI)
GI-1.Approximate size and name ofMetropolitan Statistical Area in which your institution is located:
GI-2.Which of the following categories best describes your facility?
Research FacilityConservation Ctr.
Survival CenterWildlife Refuge
Rehabilitation Ctr.Other, specify:
GI-3.Year facility was founded:
GI-4.NEW APPLICANTS ONLY: Submit a statement indicating why your facility desires AZA certification.
See flash drive N/A, currently certified
GI-5.Submit a one or twopage summary of your facility's history, including dates of major events, renovations, and other important changes.
See flash drive
GI-6.Provide your facility's mission statement. See flash drive
GI-7.Is your facility approved by USDA for importing ruminants (PPEQ)? Yes No
GI-8.Provide your facility's USDA Exhibitor License #
GI-9.Submit at least 10 photographs that best depict your facility on a typical day of operation.
See flash drive
GI-10.Submit at least 3 photographs that best depict your facility during a typical winter or cold-weather season.
See flash drive N/A, no significant winter or cold-weather season
ANIMALWELFARE,CARE, & MANAGEMENT (AC)
AC-1.Is your facility currently in compliance with all relevant local, state, and federal wildlife laws and regulations (e.g., USDA, AWA, etc.)? [1.1.1]
Yes No
a. If “no”, explain in detail:
See flash drive
AC-2.Does your facilityprovide access to approved AZA Animal Care Manuals (ACMs) for all paid and unpaid animal care staff,and follow ACMs that are specific to animals within your facility? [1.2.1, 1.2.2] Yes No
a.If “yes”, please list the names of the approved ACMs that are being referenced by your staff:
See flash drive
N/A,at this time there are no approved ACMs specific to animals within our facility
AC-3.Submit a copy of your Institutional Collection Plan (ICP). [1.3.1] See flash drive
AC-4.How often is your ICP reviewed and updated? [1.3.1]
AC-5.Describe the process used in creating your ICP. [1.3.1]
See flash drive Statement Provided Here:
AC-6.Appearing on Visiting Committee Report form only.
AC-7.Submit your facility’s most recent animal inventory in taxonomic order, including scientific name and sex. The inventory should cover a 12 month period. [1.4.1, 1.4.2]
See flash drive
a.How many animals at your facilityare on loan from other facilities?
b.How many animals at your facilityare on loan to other facilities?
c.Who owns your facility’s animals?
AC-8.Does your facility participate with Species360 (formerly ISIS)? [1.4.8] Yes No
a.What percentage of your facility's animals are registered with Species360 (formerly ISIS)? %
b.Are all of your facility's holdings of endangered, CITES I, SSP, and studbook species registered with Species360 (formerly ISIS)?
Yes No, see list on flash drive
c.Is your facility currently participating in:
ARKS or ZIMS Other:
AC-9.Submit a detailed explanation of the recordkeeping system utilized for those animals not registered with Species360 (formerly ISIS). [1.4.8]
See flash drive N/A (all animals registered with Species360 [formerly ISIS])
AC-10. Submit details on your facility's animal marking system utilized to correspond with animal records. [1.4.3]
See flash drive
AC-11.Other than those specimens registered with Species360 (formerly ISIS), are animal records duplicated? [1.4.4]
Yes No
AC-12.Describe how, and where, records (originals and duplicate sets) are stored[1.4.4]:
AC-13.Are duplicate records stored in a separate location? [1.4.4]
Yes No, explain:
AC-14.Has a paid staff member been designated as being responsible for your facility's animal record-keeping system? [1.4.6]
Yes, provide name and title: No
a.Does at least one member of your facility’s paid staff involved with record-keeping have the proper training(AZA’sInstitutional Records-Keeping course is one option)? [1.4.9]
Yes, provide name and title: No
AC-15.Are records current with up-to-date information? [1.4.7] Yes No
AC-16.Submit a copy of your facility’s policy on responsible population management (RPM Policy), including a copy of your facility’s animal loan agreement, and animal recipient profile form. [1.3.2]
See flash drive
AC-17/AC-18. Appearing on Visiting Committee Report form only.
AC-19.Does your facility surplus animals to non-AZA facilities? [AZA’sRPMPolicy] Yes No
- If “yes”, provide a detailed description of how your facility assesses the willingness and ability of the facility to provide adequate care for the animals.
See flash drive Statement Provided Here:
AC-20.Is animal welfare managed as a top priority at your facility?
Yes No, explain:
AC-21.Submit a copy of your facility’s process for assessing animal welfare and wellness, including a schedule of how often assessments are done. Include copies of at least two examples of written assessments that have been completed, describing any adjustments made as a result. [1.5.0]
See flash drive
AC-22.Does your facility assess the welfare of all animals residing there?
Yes No, explain:
AC-23.Describe your facility’s process for paid and unpaid staff to report animal welfare concerns in a non-judgmental environment and following a clearly identified protocol. [1.5.8]
See flash drive Description Provided Here:
- Provide supporting documentation (e.g., committee members, meeting minutes, inspection reports, individual complaints, etc.) to illustrate the functioning of the process and the committee overseeing the process.
See flash drive
b.How does your facility assure that concerns are received and acted on quickly?
See flash drive Statement Provided Here:
c.How and when is feedback provided to the person submitting the concern?
See flash drive Statement Provided Here:
AC-24.If your facilitymaintains elephants, are your facilities and program in compliance with AZA’s Standards For Elephant Management & Care (see pages 36 - 63 of the 2018“Accreditation Standards and Related Policies” booklet)? [1.5.6]
Yes No, explain: N/A
AC-25.If your facility maintains elephants, submit a copy of your elephant management protocols and policy, as outlined in AZA’s Standards For Elephant Management & Care(see pages 36 - 63 ofthe 2018“Accreditation Standards and Related Policies” booklet). [1.5.6] See flash drive N/A
AC-26.Does your facility have an elephant restraining device? [AZA’s Standards For Elephant Management & Care]
Yes No N/A
a.If “no”, explain in detail how your facility meets AZA standards of elephant husbandry and management regarding veterinary care and examination, method of restraint, and the ability to safely manage dominance and aggression, or the introduction of a new animal. See flash drive
AC-27.If your facility maintains elephants, submit a copy of your protocols for training new staff in your elephant management program. [AZA’s Standards For Elephant Management & Care]
See flash drive N/A
AC-28.If your facility maintains elephants, submit a copy of your elephant behavior profiles for the past 24-months. [AZA’s Standards For Elephant Management & Care]
See flash drive N/A
AC-29.If your facility maintains elephants, do you have a designated elephant manager? [AZA’s Standards For Elephant Management & Care]
Yes No N/A
a.If yes, submit C.V. See flash drive
b. If no, submit a written explanation of who is charged with direct elephant management and list their responsibilities. See flash drive Statement Provided Here:
AC-30.If your facility maintains cetaceans, are your facilities and program in compliance with AZA’s Standards For Cetacean Care & Welfare (see pages 69 - 77 of the 2018 “Accreditation Standards and Related Policies” booklet)? [1.5.6.1]
Yes No, explain: N/A
AC-31.Does your facility have a cetacean and guest interaction program? [AZA’s Standards For Cetacean Care & Welfare, Cet. 4.]
Yes No N/A
a.If “yes”, submit a description of the program in detail (where it takes place, the amount of time each cetacean participates, the ratio of guests to animals and how that is determined, the nature of the program, the duration of each interactive session, the number and nature of staff involved, etc.).
See flash drive
AC-32.If “yes” to AC-22 above, submit a description of how cetaceans that participate are trained. [AZA’s Standards for Cetacean Care & Welfare, Cet. 4.3]
See flash drive N/A
AC-33.If your facility maintains cetaceans, submit a copy of your behavior management program. [AZA’s Standards for Cetacean Care & Welfare, Cet. 6.1]
See flash drive N/A
AC-34.If your facility maintains cetaceans, do you have a designated cetacean“manager”? [AZA’s Standards for Cetacean Care & Welfare]
Yes No N/A
a.If “yes”, submit C.V. See flash drive
b. If “no”, submit a written explanation of who is charged with direct cetacean management and list their responsibilities. See flash drive Statement Provided Here:
AC-35.Submit a copy of your facility’s USDA inspection report forms (or the equivalent for those not inspected by USDA) for the last five years.
See flash drive N/A
a.If deficiencies were noted during the last inspection, submit a written report on how those items are being/have been corrected.
See flash drive N/A
AC-36.Does your animal training program ever take place in public view? [1.5.3, 1.5.4, 1.5.5, 1.6.4]
Yes No
a.If yes, submit a description of what a typical demonstration entails, including your training philosophy and protocols.
See flash drive Description Provided Here:
b.If yes, provide a list of animals that might be involved in a typical public demonstration.
See flash drive List Provided Here:
AC-37.Do any animals in your facilityspend time in a “touch pool” or “petting” environment? [1.5.4, 1.5.5, 1.5.12, 1.5.13, 11.3.3]
Yes No
- If yes, list all areas in which this occurs.
See flash drive List Provided Here:
- If yes, describe your operations protocol for supervision of each area (including hours each area is open).
See flash drive Provided Here:
- If yes, submit your operations protocol detailing recommended exposure times, animal handling policy (pick-up, touch only, etc.), and animal rotation and/or replacement policy.
See flash drive
AC-38.Are hand-washing stations and appropriate signage available and visible in all public animal contact areas? [11.1.2, AZA’s Policy on Animal Contact with the General Public]
Yes No, explain: N/A
AC-39.Submit your facility’s written animal handling training protocol required for paid and unpaid staff. [1.5.12]
See flash drive
AC-40.Does your facility use ambassador animals (animals that are used outside their normal exhibit or holding areas or are intended to have regular, physical contact with the public within their normal exhibits, e.g., contact area with domestic animals, browse feeding programs with giraffes, lorikeet feeding, etc.)? [1.5.3, 1.5.4, 1.5.5. 1.5.12]
Yes No
- If yes, submit a copy of your facility’s ambassador animal policy (including ambassador animal philosophy and contact policy) detailing recommended exposure times, animal handling policy (pick-up, touch only, etc.), training for animal handlers, and animal rotation and/or replacement policy. This policy should clearly adhere to the AZA approved Recommendations For Developing an Institutional Ambassador Animal Policy [1.5.4; Policy on Presentation of Animals, page 92, 2018AccreditationStandards; Ambassador Animal Policy, pages 81 – 82, 2018AccreditationStandards].
See flash drive
AC-41.Provide a detaileddescription of how your facility maintains ambassador animals. If they are housed separately from the rest of the animals describe their housing (include photographs) and the social, physical, behavioral, and nutritional opportunities provided for the ambassador animals). [1.5.4, 1.5.5]
See flash drive N/A
AC-42.Does your facility utilize ambassador animals in off-premises situations (i.e. shopping malls, sporting events, school programs, theatrical productions and/or television appearances, etc)? [1.5.5]
Yes No
a. If yes, submit detailed explanation, including list of animals used, a description of who handles the animals and how they are trained, your facility’s operations and safety protocols, and facility procedures to protect the rest of the animals from exposure to infectious agents. See flash drive
AC-43.Does your facility utilize animals for photo opportunities with the public where they have direct contact or could have contact with the animals? [1.5.3, 1.5.4, 1.5.5, 1.5.12]
Yes No
a. If yes, submit detailed explanation, including list of animals used, a description of who handles the animals and how they are trained, and your facility’s operations and safety protocols, and facility procedures to protect the rest of the animals from exposure to infectious agents. See flash drive
AC-44 to AC-57. Appearing on Visiting Committee Report form only.
AC-58.Describe the significant seasonal changes (hot, cold, etc.)yourfacilityissubject to, and how operations are altered as a result. Include special challenges with particular animals, exhibits, and holding areas (if any), and copies of any related protocol. [1.5.7]
See flash drive N/A, no significant seasonal change in climate
AC-59.Submit a copy of your facility’s animal enrichment program. [1.6.1]
See flash drive
AC-60.Provide the name and title of the person responsible for interdepartmental coordination of the enrichment program. [1.6.2]
Name: Title:
AC-61.Submit a copy of your facility’s animal training program. [1.6.4]
See flash drive
AC-62.If your facility’s animal inventory includes marine mammals, aquatic or semi-aquatic species, submit a detailed description of the water quality monitoring program that outlines parameters tested, allowable tolerances, frequency of testing, methods of testing, and data interpretation protocol for each major aquatic system. [1.5.9]
See flash drive N/A (no marine mammals or aquarium facilities)
AC-63.If your facility is an aquarium or has aquarium facilities, include a detailed description of how your facility determines that the collection procedures used by outside collectors are not causing environmental damage (reef blasting, cyanide poisoning, etc.), and are done in a sustainable manner. [1.7.1]
See flash drive N/A (no aquarium facilities) Statement Provided Here:
AC-64.If your facility utilizes commercial animal collectors, include a description of how your facility verifies that collectors are properly permitted to conduct legal collections (including aquatic animals) from the wild (include current and complete copies of all of their applicable local, state, federal and/or international permits required to collect the animals purchased). [1.7.2]