/ Department of Primary Industries, Parks, Water and Environment
Animal Ethics Committee
UNEXPECTED ADVERSE EVENT REPORT / Department of Primary Industries, Parks, Water and Environment
Policy Branch, Strategic Services
C/- AEC Executive Officer
GPO Box 44
Hobart, Tasmania 7001
Email:
Web:

Important Information:

  • Please observe the AEC’s reporting requirements for unexpected adverse events as set out in the AEC Operating Procedures.
  • Any unexpected event that causes an adverse effect (including an unexpected injury or death) on the welfare of an animal in the course of a DPIPWE AEC-approved projectmust be reported using this form.
  • A post-mortem must be conducted by a suitably qualified person (e.g. veterinarian or veterinary pathologist) to investigate the cause of unexpected death of any animal, and a copy included with this report.
  • Please write your responses to each question in the boxes provided – these will expand as you type. A response is required for each question. Write "not applicable" if necessary.

Section A: ADMINISTRATIVE DETAILS

AEC Project Number
Project Title
Chief investigator (include name, position and organisation)
Contact details (include email and postal address)
Phone (include business and mobile)
Approval Period of Project (please refer to your approval certificate e.g. 2 May 2013- 2 May 2015)

A1. Confidentiality

Do you consent to this information being circulated to the AEC?* / YES / NO

* Please note that information provided will be treated as confidential by the AEC and the AEC Executive Officer. However, by law, information in the possession of this Agency may be disclosed to an applicant under the provisions of the Right to Information Act 2009.

Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the Department of Primary Industries, Parks, Water and Environment (DPIPWE).

A2. Project Overview

Please give a brief description (in 400 words or less) of the original project, its aims, progress to date and any major changes that have been approved by the AEC to date.

Section B: UNEXPECTED ADVERSE EVENT DETAILS

Date of event:
Location of event:
Animal species involved (indicate whether target or by-catch species):
Brief outline of event and circumstances leading up to the event:
Probable cause of event:
Immediate impact of event on the research:
Any long-term impact of the event on the research:
Total number of mortalities or injuries incurred (include species details) out of total population:
Total realistic, maximum, acceptable mortality level (number or %) of target or by-catch species expected as a result of the nominated procedures (as stated in D6 of your approved AEC application):
Autopsy details (including autopsy personnel) and findings**:
Describe what measures were undertaken at the time of the event to minimise impact on the animals:
Describe what measures have been (or will be) undertaken, post-event, to minimise a repeat of the incident or event:

** Note: Please include a copy of the post-mortem report with this unexpected adverse event report.

B2. Inspections and Monitoring

Has your animal housing or holding facility been inspected by the AEC in the last 12 months? / YES / NO
Has the AEC requested video-recorded footage or digital photographs of your facility, remote site or project activities in the past 12 months? / YES / NO

Section C: DECLARATIONS

INVESTIGATORS INVOLVED
The outlined account represents a true and accurate description of the events as they relate to this approved project.
Name of Chief Investigator: ......
Signature: ......
Date: ......
Email: ......
All personnel involved in the event or the reporting of this eventmust sign this declaration.
(Copy and paste the information required below for additional Associate Investigators).
Name of Associate Investigator: ......
Signature: ......
Date: ......

December 3, 2018