Protocol Annual Review
Institutional Animal Care and Use Committee (IACUC)
Year 01 Year 02
Investigator(s)
Federal and University animal Assurance policies require annual reporting on the status of your animal studies. To comply with these policies, please complete the below and electronically submit this report (with your signature) to . A signed copy may also be faxed to 410-455-3868. Contact the Office for Research Protections and Compliance with any questions, 410-455-2737 or .
1. Is your animal research project numbered and titled (original approval date: ) still active?
Yes
No If no, sign the next page and return form.
2. Animal use report – please report the source and number of animals used in this reporting period. If you exceed the number of approved animals, a protocol modification must be submitted (see below).
Year 01 / Year 02Number of animals approved per protocol
Has the source of animals changed since originally proposed or the last annual review? If yes, please explain. / Yes No / Yes No
Animals housing location
Total number of animals used in this reporting period
3. Have there been any changes in the animal component of the project (i.e., increasing by small numbers additional animal subjects, changing the route of administration of drugs), the addition of new personnel or changes to sponsored funding mechanisms?
Yes If yes, a Request for Minor Change/Amendment form must be completed and attached. (available for download at http://www.umbc.edu/research/ORPC/iacuc_forms.html)
No
Explanation:
NOTE: MAJOR CHANGES IN PROCEDURES, LARGE NUMBERS OF ANIMALS OR SPECIES MUST BE SUBMITTED USING THE REQUEST FOR SIGNIFICANT CHANGE TO AN ANIMAL USE PROTOCOL
((available for download at http://www.umbc.edu/research/ORPC/iacuc_forms.html)
4. Were there any unexpected reactions, spontaneous deaths, or basic problems with the model during the past year?
Yes If yes, how many animals were affected and please explain.
No
Explanation:
5. Please list all personnel currently associated with this project. Training must be completed when individuals are listed as personnel at the time of the renewal of an expiring study or when new personnel are added to a study that haven’t taken completed training previously.
Current Training Dates
Name Title Role CITI OSHP Qualifications
Principal Investigator Date
Please return this form within 30 days or this protocol may be subject to suspension.
IACUC Protocol Annual Review Form – 08/01/2013