Submit This Form As an Attachment to a New Application in Curesearch

Please direct all questions regarding the completion of this form to the ACC Coordinator in the Carleton University Research Compliance Office at:

Submit this form as an attachment to a new application in cuResearch.

1FOR OFFICE USE ONLY

Romeo Protocol #:
Status:

2PRINCIPAL INVESTIGATOR INFORMATION

Date:
Name: / Position:
Faculty/Department:
Carleton Email:
Office Telephone: / Alternate Telephone:
Emergency Contact Designate: / Emergency Contact Phone:

3PROJECT DESCRIPTION

Title:

Start Date: End Date:

4AWARD INFORMATION

cuResearch/Romeo Award #:Status: <select one>ActivePendingCompleted

Award Type:Award Title:

5SCIENTIFIC AND PEDAGOGICAL MERIT REVIEW

5.1Has this project been reviewed for scientific merit? Yes No N/A, If no contact to arrange review through the Office of the VP Research.

5.2Is this is a teaching protocol? Yes No If ‘yes’ ensure the pedagogical merit review form has been completed and uploaded with this protocol submission.

5.2.1What is the number of students per animal and student/teacher ration?

6PROJECT TEAM MEMBERS

NAME / POSITION / PHONE / PROCEDURES / CCAC TRAINING COMPLETE**
<select one>FacultyLecturerstudentOther
Other: / Yes No
<select one>FacultyLecturerstudentOther
Other: / Yes No
<select one>FacultyLecturerstudentOther
Other: / Yes No
<select one>FacultyLecturerstudentOther
Other: / Yes No
<select one>FacultyLecturerstudentOther
Other: / Yes No
<select one>FacultyLecturerstudentOther
Other: / Yes No

**click to review the ACC training requirements

7ANIMAL INFORMATION

7.1Purpose of Animal Use (PAU): <select one>0 - breeding colonies1 - fundamental studies2 - medical studies4 - development of products5 - educational purposes

7.2Category of Invasiveness (CI): <select one>A - invertebrates or live isolatesB - little or no discomfort or stressC - minor stress or pain of short durationD - moderate to severe distress or discomfortE - severe pain

7.3In one or two sentences relate the Purpose of Animal Use to the Category of Invasiveness. For example: To study the effects of ghrelin on reproduction, food intake, body weights and reproductive cycles will be monitored in female rats.

7.4

Species/Strain / Age/Size / Sex / Source / Total # required full aup
/
/
/
/

7.5Provide justification for the species and number of animals used (provide scientific and statistical justification)

7.6Are transgenics being used? Yes No If ‘Yes’, complete remainder of this section.

7.7What is the background strain for the species you are using?

7.8Describe the genotype.

7.9Describe the phenotype

7.10What abnormities are known to exist (or do you expect) in these animals and/or will these affect lifespan and/or breeding?

8THE THREE Rs

8.1Replacement: Justify, citing references where appropriate, why this research cannot be performed with non-animal alternatives, or replacing higher order animals with lower order animals.

8.2Reduction: Describe the strategy applied to result in the fewest animals being used.

8.3Refinement: Describe opportunities for refinement, such as modification of husbandry or experimental procedures to minimize pain and distress.

9PROJECT AND PROCEDURE DETAILS

9.1In non-scientific terminology (suitable for a press release and no more than 300 words), summarize how:

A: this protocol will contribute to this field of research

B: Briefly explain the primary objective(s) and rational of the study (bullet points are preferred)

9.2Describe, clearly, all procedures and techniques using animals (details of post-mortem analysis are not required). If information is not provided in 8.2, provide a breakdown on the animal numbers by experiment. Diagrams, flowcharts and tables are encouraged.

9.3How frequently will the animals be monitored during the course of the study, by whom, and what records will be maintained?

10HOUSING AND ENVIRONMENTAL ENRICHMENT

10.1Are there any special housing or equipment needs? Yes No

10.1.1If yes, describe:

10.2Are there any special diet requirements? Yes No

10.2.1If yes, describe:

10.3Are there any medications or treatments required? Yes No

10.3.1If yes, describe:

10.4Are there any special environmental conditions (temperature, humidity, light cycle) required? Yes No

10.4.1If yes, describe:

10.5Standard housing is provided to all animals. What additional environmental enrichment are you requesting?

10.5.1In the unlikely event standard housing cannot be provided, provide a justification:

10.6Will animals be housed outside the animal holding room for more than 24 hours? Yes No

10.6.1If yes, describe:

11EXPERIMENTAL EFFECTS AND INTERVENTION

11.1 Identify any signs or symptoms that are expected based on the procedures described in 5.3

11.2What signs or symptoms will result in removal from the study?

11.3When one of the above signs or symptoms occurs, what will happen to the animal? (i.e. euthanasia, intervention, treatment)

11.3.1Specify treatment(s) or Intervention(s), if applicable. N/A

12EUTHANASIA

12.1Indicate the euthanasia method to be used, reference a SOP where applicable, or describe method.

12.2Is a physical method of euthanasia used without prior use of anesthetic? Yes No

12.2.1If yes, justify.

12.3How are animals disposed of following euthanasia?

12.4What happens to the animals, if not euthanized?

13ANALGESIA, ANESTHESIA AND SURGERY

13.1Is surgery required? Yes No If yes, complete remainder of this section.

13.2Are these surgeries: Survival Non-survival

13.3Describe surgical procedures, include a description of: reason for surgery, incision sites, tissue isolation methods, wound closure and estimate of time to complete surgery.

13.4Describe procedures to maintain a sterile field during surgery (e.g. sterile instruments – specify method, sterile surgical gloves etc.)

13.5Describe analgesics to be administered:

Name / Dose / Frequency / Route of Administration

13.6Describe the post-anesthetic and post-surgical monitoring and care procedures, including:

13.6.1maintaining body temperature:

13.6.2suture or staple removal:

13.6.3who will perform monitoring, include frequency and duration:

13.6.4Parameters that will be evaluated:

13.6.5Measures to alleviate post-operative discomfort:

13.7Are animals used in more than one major surgical procedure from which they recover? Yes No

13.7.1If yes, describe and justify:

13.8Is a neuromuscular blocking agent used? Yes No

13.8.1If yes, indicate the following: rationale, drug name, dosage, route of administration, frequency, monitoring methods

14HAZARDOUS MATERIALS

14.1Are any hazardous materials (i.e biohazard, chemical, radiological) being used in this protocol? Yes No If Yes, complete remainder of section.

14.2Specify each agent:

14.2.1 Biological (e.g. bacteria, virus, fungi, toxin etc.) No Yes, specify:

14.2.1.1Biosafety Permit Number:

14.2.2 Chemical (e.g. carcinogen, hormone, etc.): No Yes, specify

14.2.3Radioisotope(s): No Yes, specify:

14.2.3.1Radiation Permit Number:

14.3For each agent, complete the table below:

Specific Agent / Dose / Route of Administr-ation / Frequency / How Excreted by Animal / Duration of Excretion

14.4Describe the control measures used to avoid hazardous exposures (containment level, personal protective equipment, emergency procedures, waste management, etc.)

15BREEDING COLONY

15.1Are you maintaining a breeding colony? Yes No If ‘Yes’, complete remainder of section.

15.2How many animals will be used to maintain the breeding colony and describe the breeding scheme (e.g. monogamous, harem).

15.3Estimate the percentage of animals that will not be used for research or breeding (e.g. culled litter mates, wrong genotype, etc.). Explain why these animals will not be used and what will be done to minimize this number. What is the fate of these animals?

15.4Will breeding animals be used experimentally? If no, what is the fate of these animals?

15.5Indicate how individuals will be genotyped and identified/labeled.

15.6Identify who will be responsible for colony management, including weaning and record keeping?

15.7If you are generating a novel transgenic strain, provide a timetable for this process and indicate when you expect to report back to the ACC on the phenotype obtained.

N/A or

16FOOD/WATER RESTRICTION

16.1Is food/water restriction a component of the protocol? Yes No If ‘Yes’, complete remainder of section.

16.2Indicate the purpose of the restriction or scheduling. Justify the need to employ the restriction or scheduling.

16.3State the duration of the food/water restriction

16.4Describe the restricted state that is to be maintained (e.g. 85% of body weight of age match control)

16.5Provide details on the regimen used to initially achieve the state and the monitoring methods employed to assure that the desired state is not exceeded (e.g. daily body weight measurements). Note: records need to be maintained at the animal holding room).

16.6Indicate the minimal amount of food/water the animal will receive per day (provide in mg/kg or ml/kg).

17AQUATICS

17.1How is the water quality established and determined prior to the introduction of animals?

17.2How is the water filtered to remove nitrogenous/animal waste compounds?

17.3Briefly describe the system design and housing (include type of water circulation, tank size etc.)

17.4Provide the approximate housing density

17.5How often and how will tanks and equipment be sanitized

17.6What type of environmental enrichment is being provided in the tank/housing? If none, provide a justification.

18DECLARATION

By clicking “agree” you are confirming that you will comply with all the statements listed below:

1. All personnel carrying work out on this protocol are listed as Project Team Members and will complete appropriate training prior to undertaking experimental work. Any changes to this need to be submitted on the Change to Personnel Amendment (Event Form).
2. This animal use protocol has been approved and submitted by the principal investigator listed on the submission.
3. All animals in this project will be cared for and used in accordance with the principles of the Canadian Council on Animal Care as stated in the "Guide to the Care and Use of Experimental Animals."
4. All techniques and facilities used will be in accordance with the Guidelines of the Canadian Council of Animal Care and the requirements of the Government of Ontario’s Animal Research Act (1980).
5. The Animal Care Committee will be notified immediately of any revisions to this experimental protocol.

I Agree

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v.1 January 2016