Research Services
University of Tasmania
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Hobart, Tasmania 7001
Tel: (03) 6226 7283
Fax: (03) 6226 7148
/ University of Tasmania

Animal Ethics Committee

INITIAL APPLICATION FORM

Please submit the completed and SIGNED form electronically(hard copies are not required). The AEC process can take up to 8 weeks so please consider this when planning your project start date.

Note:

  • The Responsible Investigator and Nominee must be UTAS employees.
  • This form should be completed using the Instructions for applying for ethics approval sheet on the UTAS Animal Ethicswebsite.
  • Some questions have associated endnotes which provide essential information and expansions on the questions. It is essential that you read them when completing this form. Hover the curser over references numbers where available in order to see the associated relevant endnotes.

Details of the Project(Please type in the boxes provided)

Project Title [1] / Click here to enter text. /
Responsible Investigator[2] / Click here to enter text. /
School or Discipline / Click here to enter text. /
Nominee[3] / Click here to enter text. /
Associate Investigators(include position) / Click here to enter text. /
Project Commencement Date / Click here to enter a date. /
Is this an Honours project or does it incorporate an Honours project? / Yes / No

Declaration by Head of School(in some cases the head of discipline may be more appropriate)

NB: If the Head of School or Discipline is one of the investigators, an appropriate person must sign the following statement of scientific/educational merit. This will normally be the Head of School or Discipline in a related area.
  • I consider that the research investigation or teaching activity detailed in this application is justified on scientific and/or educational grounds;
  • I confirm that facilities are available to ensure the welfare of the animals whilst they are in my department;
  • I am satisfied that all personnel who will be involved with the proposed investigation are familiar and will comply with all relevant Commonwealth and State or Territory legislation and the requirements of the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes 8th edition 2013;
  • I shall ensure, as far as I am able, that I will comply with the principles of the Code throughout the investigation.

Head of School or Discipline
Name of Head of School or Discipline:Click here to enter text.
Signature:··································
Date:Click here to enter a date.
  1. Primary Purpose: Please highlight option
Teaching
Higher Degree Research
Staff Research
Teaching and Research
  • Teaching covers all teaching activities and vocational training conducted by and/or involving UTAS staff and/or students including high school and college teaching activities and demonstrations. If you have selected this option, you must also complete Attachment A relevant to teaching activities at the end of this document.
  • If you have selected Teaching and Researchyou must also complete Attachments A and B relevant to teaching activities at the end of this document.

  1. Overview of the Project
It is important to give a clear description inplain Englishbecause not all members of the committee are scientists(maximum ½ page per answer please)
2.1 What is the background that has led to this project?
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2.2 What are the major aims of the project?
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2.3 What are the anticipated benefits that justify this project?
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2.4 What will actually happen to the animals?
(This is to provide a context for your project. A more detailedanswer is required in Question 5)
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2.5 Which of the following aspects of the code does your project address?
Please highlight an option:
Increasing our understanding of humans or animals
Maintaining or improving human and/or animal welfare
Improving animal management or production
Understanding, maintaining or improving the natural environment
Achieving educational objectives

3. Are precise numbers of animals known? Yes / No

In answering this question, please consider potential mortalities associated with transportation, housing, specific transgenic lines etc., that could occur in addition to mortalities as a direct result of your research. (Important note: If additional numbers are anticipated during the course of the research, the AEC must be notified in advance).

  • If yes,insert the precise numbers on the table marked 3.1.
  • If no, please provide your estimated numbers in Table 3.2.

(Please note that these numbers can be modified annually)

3.1 Precise Numbers
Please Note: any discrepancies between the number of animals required and the number of animals delivered by a supplier MUST be addressed. If numbers cannot be precise, it may be more appropriate to complete Table 3.2 Estimated Numbers. Full details of the fate of all animals that have been oversupplied must be included in your annual report.
Species
(common and scientific names) / Strain
(if applicable) / Year / No to
be used / No to be killed / Source[4] / Location[5]
1
2
3
Total
1
2
3
Total
1
2
3
Total
Note: In the case of lab animals, in the space below, please advise whether strains are GMO’S, Knockout, Knockin or Mutations.
3.2 Estimated Numbers
Note:
Estimating exact numbers for projects is difficult and the AEC does take this in to consideration, however, the information is required under the Code of Practice so make the best estimate and explain why it is not possible to be more accurate (eg. Trapping has not been carried out in this area before.) You will need to keep the AEC regularly informed if the numbers exceed your estimate or animals you did not specify in the application. If the project runs into a second/third year you will be expected to be more accurate with your estimates in your Reporting Form. If numbers are increased you will need to submit an Application to modify an approved project.
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Species
(common and scientific names) / Strain
(if applicable) / Year / No to
be used / No to be killed / Source[6] / Location[7]
1
2
3
Total
1
2
3
Total
1
2
3
Total

Please justify the statistical validity for the number of animals requested

Comments:

4. Procedures–Please classify the proposed procedures

(please choose Yes or No. Refer to the detailed endnotes for additional information)

1. Field study/capture or study of free-living (including feral) animals [8] / Yes / No
2. Marking or tagging[9] / Yes / No
3. Behaviour observations / Yes / No
4. Harvesting of tissues from dead animals / Yes / No
5. Dissection of dead animals / Yes / No
6. Anaesthesia with subsequent recovery[10] / Yes / No
7. Anaesthesia without subsequent recovery[11] / Yes / No
8. Surgical procedures[12] / Yes / No
9. Use of neuromuscular blockers [13] / Yes / No
10. Infection with microbial agents and/or parasites/ testing of toxins [14] / Yes / No
11. Implantation/attachment of electrodes, catheters, transmitters, collars, telemetry devices etc.[15] / Yes / No
12. Blood sampling [16] / Yes / No
13. Production of antisera[17] / Yes / No
14. Forced exercise[18] / Yes / No
15. Feeding studies, including diet modification[19] / Yes / No
17. Animals with altered genetic make-up
(manipulated, modified, naturally occurring mutation) [20] / Yes / No
18. Administration of pharmaceutical agents[21] / Yes / No
19. Death as an endpoint (e.g. for toxicological studies)[22] / Yes / No
20. If there are other procedures, please detail in the box below: / Yes / No
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5. Detailed Procedures[23]

It is important to provide details (sequentially) on what happens to the animal/s from the time you obtain them until the time the project is completed. It is useful to include images where possible.

Please ensure that each procedure marked Yes in the table above is described in detail as per the endnotes (provided after the selected procedures). Please include a flow chart or sequence of events table. Your step by step description of what will happen to each animal should include the following:

  • Transport, acclimation and conditions of housing and handling;
  • Experimental and other procedures, including dose and route of any substance or treatment given and method, volume and frequency of samples collected;
  • Surgical and related procedures including dose of anaesthetic, analgesic and tranquillising agents and methods of monitoring their adequacy and side effects;
  • The sequence and timing of events from start to finish for individual animals or groups;
  • The arrangements for the animal at the completion of the project, including, if applicable, the method of humane killing;
  • Include details of the maximum time any individual animal will be held under experimental conditions;
  • Include details of where procedures are to be carried out.

Please also refer to the attached checklist to ensure all details have been considered.

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6. Monitoring by Investigators– Please detailbelow how the well-being of animals will be assessed throughout the project.

6.1 Provide details of the location, the method and frequency of day-to-day monitoring of animals before, during and after procedures (Please attach to your application a copy of the check sheet you will use to record this information)

Before Procedures: / Click here to enter text. /
During Procedures: / Click here to enter text. /
After Procedures: / Click here to enter text. /

6.2.What clinical, behavioural or other signs will be used to indicate that intervention is needed to alleviate an animal’s pain or suffering? What action will be taken if these indicators are reached?

(Please attach a copy of the check sheet you will use to record this information to your application)

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6.3Who will be responsible for the management of veterinary and other emergencies and how will it be ensured that researchers are aware of the person’s location and know how to contact them quickly?

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7Location

7.1 If the study is taking place on UTAS premises, please state exactly where.

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7.2 If the study is not taking place on UTAS premises, please state exactly where.

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8.Replacement (Code of Practice 1.18 – 1.20)

Please provide an explanation as to why animals are needed for the project. Please include:

  • a list of any potential alternatives to animal use;
  • whether any of these alternatives are being used in this project, and if not;
  • why alternatives are unsuitable for this project.

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9.Reduction (Code of Practice 1.21 – 1.27)

9.1 On the basis of experimental design and statistical analysis, explain why this number of animals will be required.Includedetails of yourestimationof animals required to cover mortalities due to events outside your research i.e. death during transportation etc.

This must be the minimum number of animals that is necessary in order to obtain a valid result.

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9.2 Is there an opportunity for sharing of tissue or animals used in the project?

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10. Refinement(Code of Practice 1.28 – 1.30)

What measures will be taken to reduce the impact of the investigation on the animals to be used?

Refinement might be achieved in a number of areas e.g. research design, procedures, housing conditions, animal handling.

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11. Animal Welfare Impact

11.1 What degree of pain, suffering or distress will be experienced by the animals during the project and how will this be measured?

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11.2 Please justify the level of pain, suffering or distress (Code of Practice 2.7.4 v)

NB: Particular justification must be given for potentially severe or ethically contentious procedures, e.g:

•Unrelieved pain and distress including where the planned end-points will allow severe adverse effects to occur (see Code of Practice ;

•Death as the end point;

•Prolonged restraint or confinement;

•Production of monoclonal antibodies by the ascites method (Code of Practice 3.3.31) and

•The use of non-human primates (Code of Practice 2.4.8 iv).

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11.3What factors affecting the wellbeing of animals will lead to premature termination of the experiment, and how will this be assessed, e.g.

  • Tumour size;
  • Maximum weight loss;
  • Excess stress of the animals.

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  1. Repeated use of Animals(Code of Practice 1.22, 1.23 and 2.3.15)

Have the animals been used in a previous project? Yes / No

If yesthe AEC will need to determine the total impact on the welfare of the animals’ involvement in multiple projects.

Please provide details, particularly with regard to the following:

Briefly describe the procedures that each animal or group of animals has been subjected to in the previous project. Highlight any pain, distress or potential cumulative effects of previous procedures. Also describe the time the animal has been used in previous project/s, the recovery period between projects and the total time the animal has been used.

13. Fate of the Animals

13.1 What will happen to the animals when you have finished with them?

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13.2 If animals are to be killed, please explain how this will be done?

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13.3 Will any animals be killed in the presence of other animals? Please justify.

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13.4 Who will kill the animals?

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14.Risks

14.1 Please specify any special risks to other animals or humans arising from the project.

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14.2 In the case of field work, what is your emergency plan for accidents involving humans?

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15. Funding

15.1If you have submitted a grant application, please provide the University of Tasmania Grant Reference Number

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15.3If your application for funding is unsuccessful, how do you intend to fund the project?

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16. References

Please provide full details of any references referred to in the text of this application.

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17. Personnel

On the following tables, list the qualifications, experience and ethics training of all personnel in this project who will be involved with live animals. Detail their experience with the species being used as well as the procedures being undertaken. In particular, when surgical or other procedures are involved, the Committee will look closely at investigators’ experience before giving approval.

Please ensure that all investigators read the following declaration:

  • I am familiar and will comply with all relevant Commonwealth and State or Territory legislation and the requirements of the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes 8th edition 2013.
  • I accept that I have a responsibility to ensure that the investigations and procedures proposed in this form are conducted fully within the conditions laid down by the Code and I undertake not to use any animals or carry out any procedures which have not been approved by the Committee.
  • I accept that the responsible investigator has ultimate responsibility for the project.

All personnel involved in the project MUST sign this document before it can be submitted to the AEC

Responsible Investigator

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Position: / Click here to enter text.
Email: / Click here to enter text. / Telephone: / Click here to enter text.
Telephone (Mobile) / Click here to enter text. / Fax: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date):
Please declare any general competing interests[24]
Signature:··································
Date:

Nominee[25] (must be a UTAS employee with experience as a Responsible Investigator. The nominee is not necessarily an associate investigator on the project)

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Position: / Click here to enter text.
Email: / Click here to enter text. / Telephone: / Click here to enter text.
Telephone (Mobile) / Click here to enter text. / Fax: / Click here to enter text.
School/Discipline: / Click here to enter text. / Internal Box No: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date):Click here to enter a date.
Signature:··································
Date:

Associate Investigator [26]

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Position: / Click here to enter text.
Email: / Click here to enter text. / Telephone: / Click here to enter text.
Telephone (Mobile) / Click here to enter text. / Fax: / Click here to enter text.
School/Discipline: / Click here to enter text. / Internal Box No: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date):
Signature:··································
Date:

Associate Investigator

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Position: / Click here to enter text.
Email: / Click here to enter text. / Telephone: / Click here to enter text.
Telephone (Mobile) / Click here to enter text. / Fax: / Click here to enter text.
School/Discipline: / Click here to enter text. / Internal Box No: / Click here to enter text.
When did you last undertake UTAS Ethics training (Approximate date):
.
Signature:··································
Date:

Associate Investigator

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Position: / Click here to enter text.
Email: / Click here to enter text. / Telephone: / Click here to enter text.
Telephone (Mobile) / Click here to enter text. / Fax: / Click here to enter text.
School/Discipline: / Click here to enter text. / Internal Box No: / Click here to enter text.
When did you last attend an Ethics Training Seminar? (Approximate date):
Signature:··································
Date:

Please copy section and add additional investigators as required

18. Competency Assessment

  1. Please provide the information for the procedures involved:

Procedure
Please list each separately e.g handling & restraint, injection (route), trapping (method), sampling (what & how) / Species
(in which procedure
is proposed) / Name of person/sperforming procedures / Level of Experience
(no. of times procedure performed)
None / Limited / High
(<5) (5-20) (>20)
If inexperienced provide name of proposed trainer / Year last performed

Note: Pursuant to the requirements of the Regulations to the Veterinary Surgeons Act 2012, persons conducting procedures defined as veterinary services[27] for the purpose of research, including sedation, anaesthesia and euthanasia, unless defined as a prescribed services,[28] are required to be assessed as competent in the procedure by a registered vet before commencing, and thereafter competence must be assessed annually. The University of Tasmania requires that the assessment of competency be made by the University Veterinarian and approved by the Animal Ethics Committee.