08/16

/ The University of Queensland Animal Ethics
Adverse Event Report Form
Animal Ethics Unit, UQ Research and Innovation
Comment: / Date
Received: / AEC Group:
Current Ethics Approval No:
Date/Signature Chairperson:
/ /

Hard copy submission of this document is no longer required. Complete forms should be hand signed, scanned, and forwarded to the relevant committee via email. For further information, please see the Animal Ethics Website.

Please use this form when reporting an adverse event to the AEC as per the Australian code of practice for the care and use of animals (Current Edition):

2.4.18.  Investigators must take steps at all times to safeguard the wellbeing of animals by avoiding or minimising known or potential causes of harm, including pain and distress, to the animals. Stepsinclude:

IX.  taking prompt action, including alleviating pain and distress and promptly notifying the AEC, in response to unexpected adverse events and emergencies, in accordance with institutional and AEC policies and procedures (see Clauses 2.1.5 [v] [d] and 3.1.24–3.1.25).

2.4.34.  Investigators must provide the following to the AEC in accordance with AEC and institutional policies and procedures:

II.  prompt notification of any unexpected adverse events (see Clause 2.1.5 [v] [d])

The AEC expects that, in the instance of an adverse event, that the AEC be notified immediately and any ongoing activities will cease until rectification/modification is made to the activity. If any clarification is required on adverse event reporting, please contact the Animal Ethics Unit Coordinator.

1. Project details

This is the latest ethics approval number for this project. Please note that providing an out of date number adds to the office workload, and consequently may delay process and communication regarding this form.

Project title:

This is the latest title for this project.

2. Investigator details

Chief Investigator:
Department/School:
Telephone:
Email:

Please ensure that all details are current and correct.

REPORT (Questions 3-6 below)

3. Describe the event or incident:

Please include in your brief description, where and when the event occurred, animals involved (species, strain, number), and personnel in attendance/involved.

4. Describe what measures were undertaken at the time of the event to minimise impact on the animals:

This should include, but is not limited to, details of the following where applicable:

a)  Veterinary assistance;

b)  Withdrawal of the animal from the activity;

c)  Euthanasia;

d)  Post mortem/pathology undertaken

5. Describe what measures have been undertaken, post event, to minimise a repeat of the incident or event: (Please see question 6 below if post event measures not yet undertaken.)

This should include but is not limited to, details of the following where applicable:

a)  Modification to the project (modification form required) such as changes to animal type; techniques; housing etc;

b)  Withdrawal of project;

6. If this is a preliminary advice of an adverse event, and post-event measures have not yet been established, please describe the current situation regarding animal welfare:

Please indicate outstanding items such as, but not limited to:

a)  Investigation strategy undertaken/to be undertaken;

b)  Outstanding reports – pathology, PM etc;

Name of Chief Investigator:
(please print or type)
Signature:
Date:

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