for best viewing - Use View-Print Layout
Florida Atlantic University

Institutional Animal Care and Use Committee

Rev. 5/09

FISH USE PROTOCOL FORM

A. ANIMAL USE PROTOCOL SUMMARY

IACUC DATE STAMP: Shaded areas for IACUC use only. / PROTOCOL NUMBER:
APPROVAL DATES: / MODIFICATION DATE:
Original:
1st Renewal:
2nd Renewal:
A.1. PROTOCOL TITLE
A.2. PRINCIPAL INVESTIGATOR (PI) NAME AND ADDRESS
First Name / Department
Last Name / Work Phone
Email Address / After Hours Phone
A.3. PROJECT PERSONNEL
(Include names of all individuals involved with the animals and this project).
ROLE IN PROJECT (please answer all that apply)
For additional names copy section and add at the end of a section.)
Name / Animal Contact:
o NONE (Not required to answer species and jobs below; General Training req’d)
o YES (Have to answer all below)
Work Phone / TRAINING: Enter dates for FAU hands on or online training (If doing Anest. and Surg., it
requires Surg. Training; Euthan. requires Euthan. Training). Also, mark an X under “OHP Enroll” to
indicate if you are enrolled in the FAU Medical Monitoring Program for Animal Users.
Email Address / Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Discuss previous training and background working with each species and each procedure marked including when trained and how trained.
Name / Animal Contact:
o NONE (Not required to answer species and jobs below; General Training req’d)
o YES (Have to answer all below)
Work Phone / TRAINING: Enter dates for FAU hands on or online training (If doing Anest. and Surg., it
requires Surg. Training; Euthan. requires Euthan. Training). Also, mark an X under “OHP Enroll” to
indicate if you are enrolled in the FAU Medical Monitoring Program for Animal Users.
Email Address / Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Discuss previous training and background working with each species and each procedure marked including when trained and how trained.
Name / Animal Contact:
o NONE (Not required to answer species and jobs below; General Training req’d)
o YES (Have to answer all below)
Work Phone / TRAINING: Enter dates for FAU hands on or online training (If doing Anest. and Surg., it
requires Surg. Training; Euthan. requires Euthan. Training). Also, mark an X under “OHP Enroll” to
indicate if you are enrolled in the FAU Medical Monitoring Program for Animal Users.
Email Address / Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Discuss previous training and background working with each species and each procedure marked including when trained and how trained.
Name / Animal Contact:
o NONE (Not required to answer species and jobs below; General Training req’d)
o YES (Have to answer all below)
Work Phone / TRAINING: Enter dates for FAU hands on or online training (If doing Anest. and Surg., it
requires Surg. Training; Euthan. requires Euthan. Training). Also, mark an X under “OHP Enroll” to
indicate if you are enrolled in the FAU Medical Monitoring Program for Animal Users.
Email Address / Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Species / Handling/monitoring / Non-Surg Procedure / General / Anest/Surgery / Euthanasia / OHP Enroll
Discuss previous training and background working with each species and each procedure marked including when trained and how trained.

To add more people, place your pointer at the top, left corner of the above group (just outside of the “N”), right click, copy and then paste just below this line. Add as many as required.

EMERGENCY CONTACT
A.4. Daily and weekend contact numbers for emergencies. (Please provide PI and an alternate’s emergency info.)
Personnel listed in this section must also be listed as project personnel in the above section
PI / Emergency Phone
Alternate Person / Emergency Phone
B.1. TYPE OF SUBMISSION (CHECK ONE) /

PROVIDE RELATED IACUC NUMBERS

New Protocol / (Not applicable for new protocols)
Year 3 Renewal of IACUC Protocol #
Identical to IACUC Protocol #
B.1.a. FUNDING SOURCE(S)
B.2. PROJECT START DATE / B.3. PROJECT END DATE
C.1. / Est.
Proj.
Tot. / PROCEDURES
Check ALL that apply / USDA Pain Level
SPECIES (Common Name) / Survival Surgery / Non-survival Surgery / Multiple Survival Surgery / Prolonged Restraint / Collection of Cells, Tissues, Organs / Aversive Conditioning / Special Diet / Food / Water Deprivation / Biohazard / Burns or Trauma / Drugs (Drugs as research components other than anesthetics, etc.) / . Immunization Procedures / Antibody Production / Diagnostic X-rays / Anesthesia without surgery (i.e. blood collection, gavage, etc.) / Paralytic Agents / Other (Specify :) / (B,C,D,E) Pain level: B-Breeding only(No tail nip); C-Only momentary or slight(needle stick); D-More than momentary or slight but relieved with medication; E-More than momentary or slight and not relieved
1
2
3
4
5
Other (Specify:)
D.1. Facility and Room # Where Procedures Will Take Place (If multiple, so indicate and if outside a facility, so state)
Non-Surgical Procedures
Surgery and/or Anesthesia
Euthanasia
Fish present a unique challenge for an IACUC because of the variety of fish and their use in research and teaching.
To help determine if the use is legal and humane, please fill out the form which is divided into sections. More than one section may apply. Please fill out all that apply.
D.2. In which category will the fish be used? (Check all that apply) Yes No
D.2.a. Aquaculture
D.2.b. Wildlife/Ecology
D.2.c. Biomedical
D.2.d. Teaching/Display
D.2.e. Behavioral Studies
D.2.f. Other
D.3. What is the proposed source of the fish? Yes No
D.3.a. Commercial (e.g., Pet shop, another institution)
D.3.b. Wildlife
D.3.b.1. Are there other vertebrate species that could be clearly adversely affected or become involved due to proximity?
If yes, please describe briefly, in your opinion, how they might be affected.
D.3.b.2.Are there permits required for the use of these animals? (Federal, state, local)
If yes, include a copy of all permits for the protocol when issued if applicable.
D.3.b.3. Are there permits required for the area (land, water, park, etc.)? )
If yes, include a copy of all permits for the protocol when issued if applicable.
If yes, as specifically as possible, describe where the area is located that the research will take place. (Attach a map if you have one.)
D.3.b.4. Will the environment be adversely changed by your research?
If yes, please briefly describe what you think will occur.
If yes, as specifically as possible, describe where the area is located that the research will take place. (Attach a map if you have one.)
D.4. Where will the fish be housed?
D.4.a. / Justification for housing on campus if from wild
D.4.b. / Building/Location / Room
D.4.c. / Approximate duration in laboratory
D.4.d. / How many times will the fish be transported to the laboratory?
D.4.e. / Who will provide the husbandry?
D.4. Will there be a Quarantine/Prophylactic treatment of incoming fish?
D.4.f. / Describe quarantine plan including special facilities, prophylaxis, etc…
D.4. Will there be Transport of fish?
D.4.g. / To ensure legal and safe transportation of animals, please describe transport.

PHARMACEUTICALS USED WITH ANIMALS

E.1. ANALGESIC/ANESTHETIC (Generic name) / SPECIES / DOSE MG/KG / ROUTE / FREQUENCY
1
2
3
4
E.2. EUTHANASIA METHOD/DRUG (Generic name) / SPECIES / DOSE MG/KG / ROUTE
1
2
3
4
E.3. OTHER DRUGS(List all injected/given i.e., antibiotics, fluids, Freund’s Complete Adj. etc.) / SPECIES / DOSE MG/KG / ROUTE / FREQUENCY
1
2
3
4
5
6
F. INVESTIGATOR ASSURANCE
READ CAREFULLY AND SIGN AND DATE BELOW
PRINCIPAL INVESTIGATOR'S ASSURANCE
I have provided an accurate description of the proposed animal care and use protocol and agree to the following conditions:
All personnel will be informed of the requirement to report fish related accidents.
All personnel will be informed that any concerns for inhumane care and treatment of fish or unlawful acts involving fish should be reported to the IACUC or the Attending Veterinarian and that anyone reporting such concerns cannot be discriminated against or be subject to any reprisal for reporting their concerns.
I agree to abide by governmental regulations and policies concerning the use of fish.
I will ensure that veterinary care is provided to animals showing evidence of pain or illness.
I agree to give consideration to tissue sharing and will do so whenever possible.
If the procedures concerning animal use in this research activity are to be revised or changed, I will so notify the IACUC of these changes before the change is implemented. I understand that failure to request an amendment for changes in animal use may place the University and myself in violation of Federal regulations.
As required by Federal regulations, I assure that the activities described do not unnecessarily duplicate previous experiments and I assure the animal models proposed are the most appropriate for achieving the objectives of this project and have provided justification for each model used in the protocol.
Principal Investigator Signature / Date

Requires a review of the protocol in a meeting with the veterinarian prior to submittal.

Attending Veterinarian’s Initials Indicating that the meeting occurred.
G. CONFIRMATION OF SCIENTIFIC/INSTRUCTIONAL MERIT REVIEW
Before any project that utilizes animals can be initiated, it must be reviewed and approved based on scientific or instructional merit. The IACUC is responsible for ensuring a scientific or instructional review is conducted, not necessarily to conduct the review. The IACUC is responsible for the proper, legal, and humane use of animals. To assure the IACUC that this review is in place, the following information is needed regarding the review process which is applicable for this protocol.
(Check one of the boxes below).
This project will only be initiated after it has been peerreviewed outside Florida Atlantic University (e.g. NIH, NSF, AHA, etc.) or within the University by a formal interdepartmental review group. If so, identify which group, agency or board has reviewed or will review this project for scientific or instructional merit.
Name of Review Agency, Committee, or Board Date of Review
OR
This project is being reviewed within FAU by one of several methods.
Departmental Committee for review of scientific or instructional merit
Name of Committee Date of Review
Name of Committee Chairperson or Official Designee of the committee indicating approval
OR
Other Review Process
Describe the review process such as the IACUC, Department Chair person, etc.
Note: While it does not necessarily require someone who is an “expert” in the field of study, it does require someone with sufficient scientific knowledge who can review a paper to ensure the project will have merit and not use animals unnecessarily. Until a review is completed and the protocol approved, the project can not be started.
Additional note: If the IACUC is asked to complete the scientific review, the project may be delayed until someone with the required expertise can be recruited.
Name of person or persons who conducted the Scientific or Instructional Merit review.
If this is to be reviewed by the IACUC, then nothing will be required in this block since the IACUC will have records of who reviewed the project.
Signature of Person / Date
In addition to any review within FAU, an “administrative review” by the chair person to indicate his/her knowledge of the project and approval is required.
Signature of Department Chairperson / Date
H. PROTOCOL SYNOPSIS
Describe the proposed use of fish in non-technical terms. Briefly outline all procedures involving the use of fish and other animals that will be affected. Focus on describing how animals will be monitored for pain and distress, and reduce excessive detail on dosages and operative techniques. Include the following subheadings, as applicable: 1) Goals/Rationale; 2) Quarantine/stabilization; 3) Procedures (with anticipated effects and what researcher and/or the veterinarian will do in response); 4) Euthanasia; 5) Breeding. Safety of personnel and other animals should also be discussed when applicable. If this is a teaching protocol, discuss how animals will be used in teaching.
NOTE: If this is a 3 year renewal, give a brief synopsis of study progress to date (research aims completed, approximate numbers of animals used) BEFORE you discuss your current proposed work.
Justification (Include why these specific fish):
Quarantine/Stabilization (If applicable):
Procedure: (Be specific, what is being done to the fish, effect on the fish, pain and relief from pain or stress, etc.)
Breeding (If applicable):
Euthanasia:
Disposal:
Other:
ANIMAL RESEARCH and TEACHING PLAN
I. RATIONALE
Federal regulations and University policy requires that fish selected for a procedure should be of an appropriate, minimum number required to obtain valid results and used at lowest pain/stress level.
I.1. Very briefly state the objective(s) and potential significance of the activities involving animal use
I.2. List each species selected and discuss its appropriateness as a research or teaching model.
(If wildlife, state species selected by [Agency] to be studied.)
I.3. Discuss the appropriateness of the NUMBER of animals to be used as follows:
State the number of animals needed for the total project. If the animals will be used for research, provide a justification, either statistical, quantitative, etc. Even pilot studies, when selecting a number of animals (i.e. 3 or 6) should have a basis for its selection. (A suggested approach is to use a statistical power calculation or a yield of tissue per organ).
Note: Wildlife studies. In wildlife study, just state the desired number to be studied and how you came up with that number, such as by an agency’s request or the expected population available.
I.4. Summarize the experimental design in a simple table or other form that graphically clarifies how the groups, time frames, and totals of animal use are broken down if possible.
J. JUDICIOUS USE OF ANIMALS
Respond to all items. For all YES responses, provide descriptions and additional information in the blanks provided. Attach additional sheets as necessary.