05/14

/ The University of Queensland Animal Ethics
Modification Form
Animal Welfare Unit, UQ Research & Innovation
Date Received / / / / Committee consideration: / AEC Group:
Date CI Advised / / / / Without change:
Approved subject to:
Modification No: / Resubmit:
Date/Signature Chairperson:
/ /
Comment:

This form, together with required number of copies, should be forwarded to the Animal Welfare Unit, UQ Research & Innovation, Cumbrae Stewart Building (72), The University of Queensland, St Lucia, QLD.

Please Note:

  • Approval of a modification does not affect the expiry date of the project’s currentethical clearance. The ethical clearance is valid only for the period shown on the Animal Ethics Approval Certificate.
  • This form should only be used for a modification to an existing approved project if it remains within the same aims of the original project. Any major changes that fall outside the original scope of the project should be submitted as a new application. If in doubt, please contact the Animal Welfare Unit.
  • If you are altering an approved project’s experimental design, it is recommended to submit a flowchart illustrating where this modification takes place within the original scope of the project. This will assist Committee members when considering this modification, especially for projects with large numbers of experiments and modifications.
  • Do notelaborate or repeat items in this modification that are already approved by the AEC to be utilised under this protocol, simply indicate “as per original application”.

Project details:

Title:
Current AEC No:
Brief overview of original project to be modified(max. 250words):
Brief details of changes to be made:(This should be dot point and not include full details e.g.
  • change of location
  • change of personnel
  • additional experiment
  • minor changes to experimental design )

Chief Investigator:
Institute/Department/School:
Contact Phone No:
Email Address:

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05/14

Type of change

/

Details of change

/

Justification for change

Change to numbers of animalsrequired:
Must indicate
  • Whether additional to original animals or in place of original animals.
  • Replacing which strains where appropriate
  • In which experiment.
  • Include transport, housing and location of experiment (if changed).
  • Do not include experimental details in this section

Addition of experiment:
Must indicate
  • Experiment number
  • Statistical justification
  • Indicate where and how this additional experiment fits into the original approval

Change to existing experimental design:
Must indicate
  • Which experiment you are changing
  • Statistical justification

Other:
  • Indicate relationship to original approval

Impact on animals:

Please describe the likely impact of the proposed changes on individual animals and explain what steps will be taken to minimise this change.

If GM animals, indicate the genotype/phenotype and any welfare implications?

Type of change

/

Details of change

/

Justification for change

Change to personnel:
Must include:
  • Qualifications
  • Experience
  • Role in project, +/- training required
  • Contact details.
  • Signed declaration below

DECLARATION OF CONSENT BY ADDITIONAL PARTICIPANTS

Name / Signature
Signature of Chief Investigator: / Date: / / /
Name of Chief
Investigator:
(please print or type)

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