AUP Number
Submitted
Approved
Annual Renewal due before

Above table to be completed by IACUC staff.

This form is to be used for the continuing review and/or modification of an existing AUP. Check the appropriate box below

Grinnell College

ANIMAL USE PROPOSAL (AUP) REVIEW. (Section 1)

And/or MODIFICATION (except personnel). (Section 2)

And/or Personnel MODIFICATION. (Section 3)

Version 10.11.2010

If you plan to continue to use vertebrate animals or modify an approved AUP, please complete the appropriate sections of the following form and submit it to the IACUC Coordinator, Jennifer Krohn, 117 John Chrystal Center, 641-269-3707. Before ordering new animals or entering existing animals into this program and before initiating projects, you MUST receive written notification of approval from the Grinnell College Institutional Animal Care and Use Committee (IACUC). Initiating work with animals prior to full IACUC approval is strictly prohibited.

Course Instructor/ Principal Investigator

Complete the following information for the individual who will be responsible for this program:

Name
Department
Phone
Email

Animal Use Proposal Number ______

Proposal Title______

Original Approval Date______

First Renewal Date______

SIGNATURES

CERTIFICATION of the PRINCIPAL INVESTIGATOR: Signature certifies that the Principal Investigator understands the requirements of the PHS Policy on Humane Care and Use of Laboratory Animals, applicable USDA regulations, and the Institution's policies governing the use of vertebrate animals for research, testing, teaching or demonstration purposes. Signature further certifies that the investigator will continue to conduct the project in full compliance with the aforementioned requirements.

______

Signature of Principal Investigator Date

Project approved Project not approved

______

IACUC Approval Signature Date

Section 1: Continuing Review Information (Year 2___, or Year 3___.)

1) ANIMAL USAGE

Species / Humane Use
Category / Total Number Approved to Date - Including Approved Modifications / Number Used to Date – Including In Use, Ordered and On Site

2) NATURE of the PROTOCOL / STUDY (check all applicable items)

Antibody Production Neuromuscular Blockers

Blood/Tissue Collection Prolonged Restraint

Breeding/Transgenic Breeding Special Events

Inducement of Behavioral Stress Survival (Chronic) Study

Inducement of a Disease State Teaching

Multiple Surgeries Terminal (Acute) Study

Other (please specify):

3) WILDLIFE PERMITS If wildlife permits are required please provide the permit number or please provide permitting agency. Submit a copy on any new applications.

4) PROTOCOL STATUS (indicate the status of this project):

Request Protocol Continuance

A. Active - project ongoing.

B. Currently inactive - project initiated but presently inactive.

C. Inactive - project never initiated but anticipated start date is .

Request Protocol Termination

D. Inactive - project never initiated.

E. Currently inactive - project initiated but has not/will not be completed.

F. Completed - no further activities with animals will be done.

5) FUNDING SOURCE (For Research Projects Only):

6) PROGRESS REPORT: If the status of this project is 4A (active - project ongoing) or 4B (project was initiated, but is presently inactive), provide a brief update on the progress made in achieving the specific aims of the protocol.

7) PROBLEMS / ADVERSE EVENTS: If the status of this project is 4A (active - project ongoing) or 4B (project was initiated, but is presently inactive), describe any unanticipated adverse events, morbidity or mortality, the cause(s) if known, and how these problems were resolved. If NONE, this should be indicated.

8) ALTERNATIVES to ANIMAL USE: Alternatives to the use of animals should be considered and used when possible. Since the last IACUC approval, have alternatives to the use of animals become available that could be substituted to achieve your specific project aims? If yes, please specify.

9) ALTERNATIVES to POTENTIALLY PAINFUL PROCEDURES: Address the following if your project involves USDA Category D or Category E: Procedures that cause the least amount of pain or distress to the animals should be considered and used when possible. Since the last IACUC approval, have alternatives which are potentially less painful or distressful become available that could be used to achieve your specific project aims?

If yes, please specify.

10) DUPLICATION: Activities involving animals must not unnecessarily duplicate previous experiments. Provide written assurance that the activities of this project remain in compliance with the requirement that there must be no unnecessary duplication.

11) MODIFICIATIONS TO THE PROTOCOL OTHER THAN PERSONNEL:

Yes No If yes, complete and submit Section 2.

12) PERSONNEL

Yes No Have there been any personnel/staff changes since the last IACUC approval was granted?

If yes, complete and submit the Section 3.

Section 2: Protocol Modification Information (except personnel)

What is considered a significant change to a project that would require IACUC review? http://grants.nih.gov/grants/OLAW/faqs.htm#d9

Examples of changes considered to be significant include, but are not limited to, changes:

·  in the objectives of a study

·  from non survival to survival surgery;

·  resulting in greater discomfort or in a greater degree of invasiveness;

·  in the species or in approximate number of animals used;

·  in anesthetic agent(s) or the use or withholding of analgesics;

·  in the method of euthanasia; and

·  in the duration, frequency, or number of procedures performed on an animal.

1.) REASON for MODIFICATION REQUEST (check all that apply):

a. Yes No Is there any change in species, strain, number, USDA Pain/Distress Classification, age, or sex of animals? If yes, please fill in table below. Note: if an increase in animal number is viewed by the IACUC as significant, the request will be considered a major change, and will require review by the full committee.)

Species / Humane Use
Category / Total Number Approved to Date - Including Approved Modifications / Number Used to Date – Including In Use, Ordered and On Site

Please explain the reason for the change. If an increase in animals is requested, please explain how the number needed was determined. The Guide recommends that the number of animals should be the minimum number required to obtain statistically valid results. A power analysis is strongly encouraged to justify group sizes when appropriate.

b. Yes No Is there any change in animal housing?

If yes, please indicate below.

c. Yes No Is there any change in the dose of a drug already in the approved protocol?

If yes, please make the required change to the drug information in the approved protocol. Please explain the reason for the change.

d. Yes No Is there any other change (personnel excepted)?

If yes, please describe below in sufficient detail for evaluation independent of any other documents.

Section 3: Protocol Modification Information for Personnel

PLEASE NOTE: a change in PI requires submission of a new Animal Use Proposal Form.

CHANGES IN NAMED PERSONNEL
[Refers to anyone who works with animals or is responsible for animals listed in the IACUC protocol, including the co-investigator, project director, post-doc, student, technician, assistant, etc. Change in principal investigator requires a new application.]
Personnel Deleted:
Personnel Added / Check Training Received / Describe the individual’s duties on the project involving animal use for the IACUC.
AUP * / SOP(s)* / OSHP
Form / Specific Duties

*Note – Principal Investigator must keep signed SOPs and written training records on file for the duration of the project. (A recommended Animal Use Personnel Training Record form is available on IACUC web site.)

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