Charles sturt university
Animal Care and Ethics Committee
Application for the Use of Animals for Teaching Purposes
This application form is restricted to proposals for teaching (practical sessions) as part of the requirements of a specific subject. A separate application must be submitted for each practical class proposal.
To expedite resolution of any minor issues raised by the ACEC during consideration of your application, please provide a mobile contact number appropriate for the duration of the relevant ACEC meeting. Alternatively, you are welcome to speak to your application at the meeting. If you wish to address the meeting, please contact the ACEC’s Governance Officer on 6338 6147.
Mobile Number:
Office Use OnlyDate Received: / / / / ACEC Agenda Item No.: / ______
Period of Approval: / / / to / / / Protocol No.: / ______
Governance Officer, ACEC ______/ Date: / ______
NOTE: This form must be typed.
1. subject code and name
You are required to enter the Subject Name as well as the Subject Code
Description of Teaching Activity
(animal handling, physiological experiments with rats and mice, etc.)
2. number of students enrolled
Internal Students
External Students
3. maximum number of students to be supervised by each teacher
4. name and designation of CHIEF instructor
Contact Details:
School or SectionSchool or Section address
Telephone
Between hours
After hours
Email Address
5. supervisory personnel (including university academic and technical staff)
Position / Title / Name / Qualifications6. dates for approval (use dd/mm/yy format)
If your teaching project is span multiple days, or if it is likely that it will need to be repeated due to adverse circumstances for the proposed teaching program, please ensure that the dates for which approval is requested encompass an appropriate timeframe. PLEASE NOTE THAT TEACHING ACTIVITIES INVOLVING ANIMALS MAY ONLY BE CONDUCTED WITHIN THE TIMEFRAMES APPROVED BY THE ANIMAL CARE AND ETHICS COMMITTEE.
From: To:
For ongoing work where methodology does not change, you may apply for an approval period of up to three (3) years after the proposed commencement date, as the ACEC can approve ongoing projects for up to 3 years subject to receipt of annual reports (ACEC T2). Please note that Annual Review Forms are required under the Australian Code for the Care and Use of Animals for Scientific Purposes (2.4.34)
7. animals to be studied
SPECIES / Scientific Name / Breed / Strain / Sex / NUMBERto be used
per year
8. origin of animals
Declaration by Manager, Animal House / Manager, Holding Facility:
Please cross out the sections below that do not apply
I confirm that housing is available in the Animal House / Holding Facility for the number of animals requested for the teaching period nominated, and that the Animal House / Facility staff can provide adequate maintenance and care of the animals during that time
OR
Housing will be available for ______animals in the Animal House / Holding Facility for the teaching period nominated. Additional housing will be provided at:
______
There will be staff at both facilities to provide adequate maintenance and care of the animals during that time.
OR
Housing and staff to provide adequate maintenance and care of the animals are not available in the Animal House / Holding Facility for the animals requested during the teaching period nominated.
Name:
Signed:
Animal House / Facility name:
Date:
Declaration by CHIEF INSTRUCTOR:
I have personally inspected the animal housing / holding facility to be used during this teaching project, and I am satisfied in regard to the smooth running of the housing facility for the duration of the project.
Signature:
9. location where teaching project is to be conducted:
10. A. ARE LICENCES REQUIRED?
Choose one: Yes o
No o
If YES, do the Supervising staff have the appropriate licences?
Choose one: Yes o
No o
If a current licence is not held and is required, then any approval will be subject to the ACEC being notified of receipt of a licence and advised of the type of licence, licence number and licence expiry date. The study may not commence without a licence.
Provide details
Staff Member / Type of Licence / Licence Number / Expiry DateB. HAVE ANY OF THE PEOPLE PARTICIPATING IN THE PROJECT HAD ANY ANIMAL RESEARCH AUTHORITY OR ANIMAL SUPPLIER’S LICENCE CANCELLED?
Choose one: Yes o
No o
If YES, please provide details including the name of the person, the date on which the authority or licence was cancelled, who cancelled the authority and the reason for cancellation:
Name of Staff Member / Date Authority / Licence Cancelled / Name of Cancelling Body / Reason for Cancellation of Authority / Licence11. A. use of animals (please check the box against against the applicable category)
DissectionFeeding Experiments
Behaviour Experiments
Physiological Experiments
Pharmacological Experiments
Immunological Experiments
Other (please specify)
B. i) JUSTIFICATION FOR THE NUMBER OF ANIMALS TO BE USED
ii) WHAT STEPS HAVE YOU TAKEN TO “REDUCE, REFINE OR REPLACE”?
C. JUSTIFICATION FOR THE USE OF ANIMALS IN TERMS OF BENEFIT TO THE TEACHING PROGRAM
D. WHAT NON-ANIMAL ALTERNATIVES HAVE BEEN CONSIDERED? EXPLAIN WHY IT IS NOT POSSIBLE TO USE THESE AND WHY THEY ARE NOT APPROPRIATE.
E. HAVE ANY ANIMALS TO BE USED IN THIS PROJECT BEEN THE SUBJECT OF PREVIOUS RESEARCH OR TEACHING PROGRAMS?
Choose one: Yes o
No o
Unknown o
If YES, give justification for use of these animals in this program:
F. i) PLEASE INDICATE THE MINIMUM AND MAXIMUM NUMBER OF ANIMALS TO BE USED BY EACH STUDENT
Minimum
Maximum
ii) PLEASE INDICATE THE MAXIMUM NUMBER OF TIMES EACH ANIMAL WILL BE USED
12. personnel
Indicate person(s) responsible for procedures used on animals (eg., euthanasia). Please tell the Committee what experience the person has relevant to the procedure to be performed, and how many years’ experience in that field that nominee has.
Name / Qualifications and Experience / Procedure13. will students perform experiments / procedures?
Choose one: Yes o
No o
If YES, who will instruct students in procedures to be carried out? Indicate experience of the instructor in the application of these techniques.
14. how will the attainment of the education objectives be assessed?
15. outline the treatment of animals before, during, and after use.
Factors may include handling, housing, etc., as well as specific procedures. Refer to the CHECKLIST at the end of this application form to ensure all details have been considered and refer to published Standard Operating Procedures where appropriate.
Where possible, attach a protocol of procedures to be used.
Include detail on the location and care of animals during the proposed period. ALL procedures MUST be in accordance with the prescribed Code of Practice under the Animals Research Act 1985 (NSW) and Animal Research Regulation 1995.
Please list any Standard Operating Procedures which are to be used – please refer to the ACEC Register of Standard Operating Procedures on the ACEC website for a complete list of Standard Operating Procedures (SOPs) already approved by the Animal Care and Ethics Committee. If you are submitting a new Standard Operating Procedure for approval by the Committee, please insert “None- New for Approval” under “SOP Number”.
SOP Number / SOP Name16. A. justify all procedures which have the potential to cause pain or distress
B. DETAIL STEPS TO BE TAKEN TO AVOID OR MINIMISE THE PAIN OR DISTRESS
17. who will monitor the animals -
A. During weekdays?
Please tell the Committee what experience the person has relevant to care of the species to be used in the project, and how many years’ experience with those animals that nominee has.
Name / Qualifications / Experience with Species UsedB. At night (If applicable)?
Please tell the Committee what experience the person has relevant to care of the species to be used in the project, and how many years’ experience with those animals that nominee has.
Name / Qualifications / Experience with Species UsedC. During weekends and holidays?
Please tell the Committee what experience the person has relevant to care of the species to be used in the project, and how many years’ experience with those animals that nominee has.
Name / Qualifications / Experience with Species Used18. . describe how the animals will be monitored
A. While the procedures are being carried out.
Include frequency and methods used.
B. For the duration of the project.
Include frequency and methods used.
19. A. METHOD(S) OF DISPOSAL OF ANIMALS ON COMPLETION OF PROGRAM(S)
B. EUTHANASIA OF ANIMALS
Where animals are to be euthanized for preparation of whole animal or tissue specimens, or at the conclusion of experimentation, or due to an unforeseen injury, provide details of the method of euthanasia, eg., cervical dislocation, carbon dioxide asphyxiation, anaesthetic overdose, other.
Euthanasia of any animals under these circumstances is to be reported to the Animal Care and Ethics Committee within forty0eight (48) hours.
For cervical dislocation, give details of the experience of the person carrying out of the procedure. For anaesthetic overdose, indicate which anaesthetic will be used and give details of route of administration and dose rate.
In the event of an unforeseen incident that requires euthanasia of an animal, I declare that this will be performed humanely by a registered veterinarian. If not, the alternative I propose is set out below:
(A blank space below, with just a signature, will be taken as assent with this clause)
Signature
How is death confirmed?
What material, if any, is to be collected?
20. describe steps to be taken to ensure the safety and health of surviving animals in this program
21. are there any features of the proposal which raise special ethical consideration?
Choose one: Yes o
No o
If YES, give details.
22. Has an application been made to any other animal ethics committee to conduct the same project, or another substantially similar?
Choose one: Yes o
No o
If YES, please indicate who the other Animal Ethics Committee is, and the name / nature of the project:
Declaration of Responsibilities
A. Declaration by Subject Co-Ordinator
I certify that the use of animals in this project will conform with the NSW legislation and the general principles of the NHMRC / CSIRO / ARC / AVCC Australian Code for the Care and Use of Animals for Scientific Purposes. I accept responsibility for the conduct of all procedures detailed in this application and for the supervision of all personnel delegated to perform any such procedures and understand it is an offence to conduct experiments unless approval in writing from the University’s Animal Care and Ethics Committee (ACEC) has been received.
I confirm that all supervisory personnel have read this application and have agreed to comply with procedures described and any conditions imposed by the ACEC.
I confirm that I have taken into account potential hazards to staff working with animals in this project, and have ensured that appropriate safety measures have been implemented.
Subject Co-Ordinator:______(Signature) / Date: ______
(Print Name)
B. Declaration by Head of School / Section (as applicable)
I have read this application and am satisfied that the use of animals is justified on scientific, educational or diagnostic grounds.
Head of School / Section:______(Signature) / Date:______
(Print Name)
School / Section:______
Submit this form to: The Governance Officer, Animal Care and Ethics Committee
Office of Governance and Corporate Affairs
Email:
CHECKLIST
² What is happening to the animals?
² What will be the effects?
² How will the effects be minimised?
Anaesthesia / Euthanasia / Toxicology Fasting / Method / Substance
Induction – drug, dose, route / Location (where procedure will be performed) / Volume
Route
Maintenance – drug, dose, route / Expertise of personnel / Frequency of treatments /
Methods of monitoring anaesthesia and recovery / Total number per animal
Local and systemic effects
Additional support during anaesthesia and recovery (e.g., heat, intravenous fluids) / Genetic Manipulation
Methods
Potential effects / Anaesthesia or analgesia
Restraint
Animal monitoring (methods and
Location of induction and recovery areas / frequency
Endpoint / duration
Housing / Tumour / neoplasia induction
Behaviour Modification / Location / Method
Stimulus (type, duration, frequency) / Group housing (stocking rates, sexes) / Site
Endpoint
Isolation / Animal monitoring (methods,
Blood / Body Fluid Collection / Shelter / frequency
Volume / Bedding
Route / Hiding areas / Transport
Frequency / Environmental enrichment / Type
Anaesthesia or analgesia / Duration held / Duration
Restraint / Conditioning period / Confinement
Animal monitoring (methods & frequency) / Numbers of animals
Air conditioning
In-vitro Studies
Diet / Water Modifications / Source of animals / Teaching
Type / Duration held / Source of animals
Amount / Euthanasia / Housing
Effects / Duration held
Measurement of Intake / Surgery / Method of disposal
Animal Monitoring / Anaesthesia
Location of pre-operative preparation area / Wildlife Studies
Location
Drug Treatments / Surgical procedure (site, technique) / Methods
Capture methods
Substance
Volume / Sterile technique (instruments, drapes, surgeon) / Handling methods
Handling / restraint
Route
Frequency / total number per animal / Location of and housing in post-operative recovery area
Post-operative management / Housing / holding
Monitoring
Release
Local and systemic effects
Anaesthesia or analgesia / Post-operative monitoring (methods, frequency, duration) / Effects on population
Possible side effects
Restraint / Use of analgesics (type, dose, route, frequency, means of determining necessity for use)
Expertise
ACEC T1 Page 7
last updated 25.07.16