APPLICATION FOR THE USE OF ANIMALS IN RESEARCH OR TRAINING
1. ADMINISTRATIVE INFORMATION (Please type)
Principal Investigator:
Position:
Faculty/Department:
Title of Project:
Is this application: New ( ), or a Renewal ( )
Expected Date of Commencement:
Expected Date of Conclusion:
EMERGENCY CONTACT:
Name:
Work Phone:
Home Phone:
DECLARATION:
All animals used in this research project will be cared for in accordance with the recommendations of the Canadian Council on Animal Care and the requirements of the provincial legislation entitled "The Universities Act", Section 52, of the Province of Alberta.
Signature of Principal Investigator:
Date:
2. DESCRIPTION OF USE:
A) Purpose of Animal Use (PAU). Circle the number (1-5) below that best describes the purpose of animal use.
1. Studies of a fundamental nature in sciences relating to essential structure or function (e.g., biology, psychology, biochemistry, pharmacology, physiology, etc.).
2. Studies for medical purposes, including veterinary medicine, that relate to human or animal disease or disorders.
3. Studies for regulatory testing of products for the protection of humans, animals, or the environment.
4. Studies for the development of products or appliances for human or veterinary medicine.
5. Education and training of individuals in post-secondary institutions or facilities.
B) Describe in terms understandable to the non-scientist how the proposed use of animals will contribute to the advancement of science, or to the development of knowledge that can reasonably be expected to benefit humans or animals.
C) Why is it necessary to use live animals? Provide rationale for your choice of species.
D) Details of Procedures to be Performed on Animals:
Do not include copies of grant proposals.
Descriptions must be sufficiently detailed to allow assessment of compliance with Canadian Council for Animal Care (CCAC) guidelines.
Use terminology understandable to Committee members with widely differing backgrounds, including non-scientists. Use additional pages if necessary.
i) Describe all procedures and manipulations using live animals for each species being used. (Note: Death as an endpoint is unacceptable.)
ii) For chronic studies, describe the care to be provided and specify a monitoring schedule of the chronic animals. Each species is to be described separately. State whether or not multiple procedures are to be performed on each animal. Flow diagrams may be helpful in clarifying the chronological order of procedures.
iii) For field studies, involving trapping animals, give the time and frequency for checking traps as well as a description of any manipulations and precautions taken to protect the animal and/or you. Also describe the holding and release of captured animals.
iv) For complex projects with many procedures or those with routine procedures it is easier to develop standard operating procedures (SOPs) in consultation with BSAS. These can then be attached to your application, and referred to from this section.
3. PAIN AND DISCOMFORT:
A) Do you anticipate any pain and/or distress associated with the procedures or manipulations? ( ) Yes ( ) No
If Yes, please describe the pain and/or distress and how it will be alleviated or minimized.
B) If animals encounter pain and/or distress what criteria will be used to terminate the experiment and possibly euthanize the animals? eg. loss of consciousness, tissue damage, tumour size, injury, etc.
4. ANIMALS:
A) Requirements:
Animal Strain Source Num. needed at a time Annual total
B) Why do you require these numbers of animals?
5. ADMINISTERED AGENTS
Indicate all agents to be administered in the research protocol for each species: (i.e. radiocollars, legbands, anaesthetics, analgesics, tranquillisers, antigens, antibiotics, tumours, radioisotopes, drugs, etc.).
Species Agent Purpose Route Dosage Frequency
6. SAMPLES
Indicate all samples to be taken for each species: (i.e. blood, ascites fluid, tissues, etc). Note: samples collected after sacrifice need not be included.
Species Type of sample Site Amount Procedure Frequency
7. SURGERY:
If not applicable check ( ) and proceed to 8.
Surgical procedures must be in accordance with established veterinary practice in the Province of Alberta. It must be carried out in an appropriate location designed for that purpose. The location of survival surgery in chronic animals must be approved by the Biosciences Animal Policy and Welfare Committee.
Location for surgical procedures:
8. METHODS OF EUTHANASIA FOR EACH SPECIES:
| Species | | | |
| C02 Chamber | | | |
| Pentobarbital | | | |
| Cervical Dislocation | | | |
| Decapitation | | | |
| Other (specify) | | | |
9. POSSIBLE HAZARDS TO STAFF OR TO ANIMAL POPULATION:
List all biohazardous agents which will be used in live animals. Describe any risk to the animal care staff or to the animal population, and indicate measures taken to reduce the risk.
10. QUALIFICATIONS AND EXPERIENCE:
A) Will all technical procedures involving animals be conducted by BSAS staff?
B) Complete the following only if you answered no to question 10A.
List names, positions, and relevant training and experience (not just degrees) of all individuals who will be working directly with the animals. Each individual must initial this form, indicating that they have read the entire application form, before submission. Note: BSAS will arrange training sessions if required.
Name Position Prior Experience Initials
I hereby certify that the above person(s) is (are) qualified to conduct the procedures described and that they have read and personally initialled this application.
Signature:
Date:
NOTE: This ethics form has been modified from the actual form used by BSAS; this form is only to be used for the course assignment in Psyco 486B1 (Winter term 2002).