Declaration by Head of School(In Some Cases the Head of Discipline May Be More Appropriate)

Research Services
University of Tasmania
Private Bag 01
Hobart, Tasmania 7001
Tel: (03) 6226 6236
Fax: (03) 6226 7148
/ Animal Ethics Committee
MINIMAL RISK
INITIAL APPLICATION FORM

The AEC Minimal Risk Initial Application form is a simplified version of the Initial Application for University based research form and should only be used for field observational studies where animals are not approached. The AEC Minimal Risk Initial Application form cannot be used for studies that propose to attract animals, e.g. using baited rather than passive cameras. If you are unsure, please contact or call 6226 6236.

Review of Ethical Considerations
Please review the following questions below to determine whether the Minimal Risk Initial Application Form is best suited for the purposes of your project, if you answer yes to either of the questions then you cannot submit a minimal risk form and must complete a full Initial Application.
Are the animals captive?
(If you answered yes a full animal ethics application is required)
Do you intend to alter the behaviour or physiology of the free ranging animals in any way or use devices or strategies which might alter their behaviour or physiology (e.g. lures)
(if you answered yes a full animal ethics application is required) / Yes No
Yes No

Please submit the completed and SIGNED form electronically(hard copies are not required).

Details of the Project(Please type in the boxes provided)
The Responsible Investigator and Nominee must be UTAS employees
Project Title [1] / Click here to enter text. /
Responsible Investigator[2] / Click here to enter text. /
School or Discipline / Click here to enter text. /
Nominee[3] / Click here to enter text. /
Associate Investigators(include position) / Click here to enter text. /
Project Commencement Date / Click here to enter a date. /
Is this an Honours project or does it incorporate an Honours project? / Yes / No

Declaration by Head of School(in some cases the head of discipline may be more appropriate)

NB: If the Head of School or Discipline is one of the investigators, an appropriate person must sign the following statement of scientific/educational merit. This will normally be the Head of School or Discipline in a related area.

I consider that the research investigation or teaching activity detailed in this application is justified on scientific and/or educational grounds and meets the criteria of minimal risk;
I am satisfied that all personnel who will be involved with the proposed investigation are familiar and will comply with all relevant Commonwealth and State or Territory legislation and the requirements of the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes 8th edition 2013;
I shall ensure, as far as I am able, thatproject staff will comply with the principles of the Code throughout the investigation.

Head of School or Discipline
Name of Head of School or Discipline:Click here to enter text.
Signature:··································
Date:Click here to enter a date.

Primary Purpose: Please highlight option

Teaching
Higher Degree Research
Staff Research
Teaching and Research
2. Overview of Project
It is important to give a clear description inplain Englishbecause not all members of the committee are scientists(maximum ½ page per answer please)
2.1 What is the background that has led to this project (please include references)?
Click here to enter text.
2.2 What are the major aims of the project?
Click here to enter text.
2.3 What are the anticipated benefits that justify this project?
Click here to enter text.
2.4 Which of the following aspects of the code does your project address?
Please highlight an option:
Increasing our understanding of humans or animals
Maintaining or improving human and/or animal welfare
Improving animal management or production
Understanding, maintaining or improving the natural environment
Achieving educational objectives
3. Animal Numbers
If it is likely there will be more animal species than you are able to fitin the list provided please add more rows
Species
(common and scientific names) / Strain
(if applicable) / Year / No to
be observed (please group into 10s, 100s or 1000s) / Location[4]
1
2
3
Total
Comments:
4. Detailed Procedures[5]
It is important to provide details (sequentially) on how you will conduct observations and what happens to the animal/s from the time you observe them until the time the project is completed. It is useful to include images where possible.
Your step by step description of what will happen to each animal should include the following:

Behavioural observations
The sequence and timing of events from start to finish
Include details of where procedures are to be carried out
Any other minimal risk procedures

Click here to enter text. /
5. Duty of Care
As a University of Tasmania staff or student, you are expected to take all reasonable measures to ensure the welfare of animals. In the unlikely event that intervention is needed to alleviate an animal’s pain or suffering, please acknowledge that all investigators/teaching staff and students are willing to take reasonable actionsto alleviate animal suffering
Yes
6. Location
6.1 Where is your study taking place?
7. The Three Rs: Replacement (Code of Practice 1.18 – 1.20)
Reduction(Code of Practice 1.21 – 1.27)
Refinement(Code of Practice 1.28 – 1.30)
7.1 The Three Rs are cornerstones of the Australian Code for the care and use of animals for scientific purposes and still need to be taken into account, even in a minimal risk project, please acknowledge that these have been appropriately considered
Yes
8. Risk Management
8.1 What measures will be taken to ensure that the investigation has minimal risk only to the animals being observed?
Click here to enter text. /
8.2Please provide either the departmental risk assessment number or attach other evidence that a department risk assessment has been undertaken. This application will not be assessed without this evidence.
Departmental Risk Assessment Number:
Description of other evidence attached:
9. References
9.1 Please provide full details of thereferences referred to in the text of this application.
Click here to enter text. /
10. Personnel
Please ensure that all investigators read the following declaration:

I am familiar and will comply with all relevant Commonwealth and State or Territory legislation and the requirements of the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes 8th edition 2013.
I accept that I have a responsibility to ensure that the investigations proposed in this form are conducted fully within the conditions laid down by the Code and I undertake not to use any animals or carry out any procedures which have not been approved by the Committee.
I accept that the responsible investigator has ultimate responsibility for the project.

All personnel involved in the project MUST sign this document
Please copy section and add additional investigators as required

Responsible Investigator

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Staff Position: / Click here to enter text.
Staff ID: / Click here to enter text. / Qualifications: / Click here to enter text.
Email: / Click here to enter text. / Telephone(mobile): / Click here to enter text.
School/Discipline / Click here to enter text.
Contact Address: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date):
Briefly detail experience with the species and the procedures:
Signature:··································
Date:

Nominee[6] (must be a UTAS employee with experience as a Responsible Investigator. The nominee is not necessarily an associate investigator (AI) on the project. If the person is both the nominee and the AI, the nominee section must be fully filled in, however, only their name needs to be filled in for the AI)

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Staff Position: / Click here to enter text.
Staff ID: / Click here to enter text. / Qualifications: / Click here to enter text.
Email: / Click here to enter text. / Telephone(mobile): / Click here to enter text.
School/Discipline: / Click here to enter text.
Contact Address: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date):Click here to enter a date.
Briefly detail experience with the species and the procedures:
Signature:··································
Date:

Associate Investigator [7] (non-student)

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Staff Position: / Click here to enter text.
Staff ID: / Click here to enter text. / Qualifications: / Click here to enter text.
Email: / Click here to enter text. / Telephone(mobile): / Click here to enter text.
School/Discipline: / Click here to enter text.
Contact Address: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date): Click here to enter a date.
Briefly detail experience with the species and the procedures:
Signature:··································
Date:

Associate Investigator (non-student)

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Staff Position: / Click here to enter text.
Staff ID: / Click here to enter text. / Qualifications: / Click here to enter text.
Email: / Click here to enter text. / Telephone(mobile): / Click here to enter text.
School/Discipline: / Click here to enter text.
Contact Address: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date): Click here to enter a date.
Briefly detail experience with the species and the procedures:
Signature:··································
Date:

Associate Investigator (non-student)

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Staff Position: / Click here to enter text.
Staff ID: / Click here to enter text. / Qualifications: / Click here to enter text.
Email: / Click here to enter text. / Telephone(mobile): / Click here to enter text.
School/Discipline: / Click here to enter text.
Contact Address: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date): Click here to enter a date.
Briefly detail experience with the species and the procedures:
Signature:··································
Date:

Please copy section and add additional investigators as required

Student Investigator

Title: / Click here to enter text. / First Name: / Click here to enter text.
Surname: / Click here to enter text. / Student ID: / Click here to enter text.
Date of Birth: / Click here to enter text. / Level: / Undergraduate / Honours / Masters /Postgraduate Diploma / DBA / PhD
Email: / Click here to enter text. / Telephone (mobile): / Click here to enter text.
School/Discipline: / Click here to enter text.
Contact Address: / Click here to enter text.
When did you last undertake UTAS Ethics Training (Approximate date): Click here to enter a date.
Briefly detail experience with the species and the procedures:
Signature:··································
Date:

Student Investigator

Please copy section and add additional student investigators as required

Conflicts of Interest
Do any of the researchers have a conflict of interest or what could be perceived as a conflict of interest?
Yes No
If yes, please provide details
A conflict of interest in the context of research exists where:

a person’s individual interests or responsibilities have the potential to influence the carrying out of his or her institutional role or professional obligations in research; or

an institution’s interests or responsibilities have the potential to influence the carrying out of its research obligations.
A perception that a conflict of interest exists can be as serious as an actual conflict.
12. Other Authorities Involved
12.1 External Authorities
Are there any external authorities involved in the project? Yes / No
If Yes, please provide details of the relevant authority (including approval numbers and dates). Please append copies of approval notifications.
Click here to enter text.
Government departments? (re. approval of joint projects)[8] Yes / No
Click here to enter text.
Government departments? (re.provision of permits) Yes / No
Click here to enter text.
Other Universities? Yes / No
Click here to enter text.
Any other external authority e.g. industry partners, other institutions, other persons Yes / No

Click here to enter text.

Other Animal Ethics Committee Yes / No

Click here to enter text.

Declaration by External Authority

If any external authorities are responsible for the daily care of animals a signature must be provided.

I confirm that I will be responsible for the daily care of the animals for the research period.

Name:Click here to enter text.
Signature:··································
Department/Organisation:Click here to enter text.
Date:
AEC Minimal Risk Initial Application Form December 2017 / Page 1 of 9

Endnotes and further information relating to the form:

[1] Title: The title should be concise but specific. Please include species name - both common and scientific.

[2] Responsible (Chief) investigator: The Committee accepts the Australian Code of Practice policy that one person is ultimately responsible for the project. Accordingly, joint responsible investigators must not be named. The person named as the Responsible Investigator (RI) must be a member of the University staff on an academic or equivalent grade. Supervisors will therefore normally be the responsible investigators for projects involving honours and postgraduate students. The RI should at all times be aware of experimentation being conducted by members of a team.

[3] Person who has experience as a Responsible Investigator and is qualified to take responsibility in the absence of the Responsible Investigator above.

[4] ‘Location’ refers to the state/country in which the animals were used. Please select one number from the list below. If the same species has been used in 2 or more different locations, please select number 10 and provide a breakdown of the number of animals used in each location in the ‘Additional information’ box below the table.

Tasmania
Victoria
New South Wales
Queensland
Northern Territory
South Australia
Western Australia
Australian Capital Territory
Overseas
Species used in more than one state/country (please provide a breakdown of the number of animals used in each location in the ‘Additional Information’ box below the table).

[5] Detailed procedures: Give a clear step-by-step description of the design of the investigation and all procedures to be carried out on each group of animals from the beginning to the end. The duration of all procedures and time sequence must also be clear. Flow charts, diagrams and/or tables may be helpful. It must be clear which investigators will carry out particular procedures and WHERE the procedures will be performed. The Committee must be satisfied that pain or distress to animals is avoided or, if this is not possible, minimised. Applications will be examined carefully in this respect. Investigators must give detailed and specific information about any procedures that have the potential to cause pain or distress.

[6] Nominee: Normally one of the associate investigators will be named as the nominee. The nominee must be able to act as the responsible investigator when necessary and therefore must be a member of the University (or in the case of AMC applications, an AMC staff member) , staff on an academic or equivalent grade. In the event of the nominee not being an associate investigator he/she must nonetheless have thoroughly read the proposal and be fully conversant with the project. The nominee will assume the responsibilities of the Responsible Investigator during any absence of the CI.

[7] Associate investigators: Any other persons who will perform procedures on live animals as part of a research project or teaching exercise must be named as associate investigators and must sign on the application form to confirm that they are familiar with the Australian Code. ‘Procedures’ include benign procedures/manipulations such as diet manipulation. For teaching practicals involving a number of undergraduate students, details must be provided on the Student Declaration Form found under the Animal Ethics Heading at:

[8]Government departments (re approval of joint projects): In the case that DPIWE or PWS has daily care of the animals, the signature of the person who will look after the animals must be obtained before this application is submitted. (See Section H: Declarations).