University Committee on Laboratory Animals

March 2013

FORMB

UNIVERSITY COMMITTEE ON LABORATORY ANIMALS

RENEWAL AND AMENDMENT FORM

PROTOCOL NUMBER:

PROJECT TITLE:

PRINCIPAL INVESTIGATOR:

DEPARTMENT:

Is this an AMENDMENTto an approved protocol?
YES NO If YES, complete PART 1only
Is this a RENEWAL of an approved protocol?
YES NO If YES, complete PART 2only
Is this a RENEWAL with AMENDMENTS?
YES NO If YES complete PART 1 and PART 2

PART 1 - AMENDMENT (S):

NOTE:Only minor amendments to existing protocols can be approved on a FORM B. Substantial modifications, such as a change in experimental objectives, or an increase in the category of invasiveness, will require a new FORM A submission.

a.Describe any amendments to this protocol, including changes in animal species / strain, housing, procedures, pharmacological agents, etc. Include changes to animal handling / care / outcomes that may result from these changes. (this answer section will expand)

b.Why are these amendments necessary? (this answer section will expand)

c.Are additional animals required for this amendment? YES NO

If yes, what species and how many additional animals/species?

d.Add any new personnel involved in this protocol.

(include Name / Position / Certification # and Phone #for each):

List any personnel who have left the project:

Principal Investigator SIGNATURE: DATE:

(office use only) Approval Date: Expiry Date: ______

FORM B

PART 2 - RENEWAL

NOTE:Approved protocols can be renewed / extended for one additional year. At the end of the second year a complete protocol application (FORM A) must be submitted for ongoing work.

ANIMAL NUMBERS:

a. For each species, what is the TOTAL number of animals you justified in the experimental design of the Form A you submitted last year?

b. How many animals of each species did you actually use last year (year 1)?

c.For each species, how many animals will you require for the upcoming year (year 2)?

The numbers in (b) plus (c) should be less than or equal to the number in 2(a). If not, then you are requesting animals that were not justified in the original protocol. In that case, please fill out the amendment section (Part 1) of this form, including additional animal numbers is section c, and justifying their use is section b.

PROGRESS REPORT:

a.Briefly describe the progress made in this study to date: (this answer section will expand)

b.Describe any unexpected animal morbidity or mortality encountered under this protocol.

Approximately how many animals were affected? (this answer section will expand)

c.Have you refined any of the experimental techniques in order to improve animal well being?

If so, please describe. (this answer section will expand)

d.Were the humane endpoints you described in Section 7 of the original protocol adequate to achieve experimental objectives, while still ensuring animal welfare? (comments can expand if needed)
YES NO Comments:

e.For field studies, were any non-target species captured or adversely affected? YES NO
If yes, how many were affected, and what happened to them?

PERSONNEL:

If there are any changes in the personnel involved in this project please complete the appropriate section in PART 1.

Principal Investigator SIGNATURE: DATE:

(office use only) Approval Date: Expiry Date:______

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