Harvard Medical Area (HMA) Standing Committee on Animals Established in 1907

Harvard Medical Area (HMA) Standing Committee on Animals – “Established in 1907”

180 Longwood Avenue, Suite 113 Boston, MA 02115Tel: 617-432-3192Fax: 617-432-3169

Dual Protocol Assignment Request

Purpose: to request assignment of animals to two protocols (a Primary and a Secondary Protocol) within a limited scope of procedures.

The Primary protocol will be the protocol to which the animals are assigned and the Secondary protocol will be the protocol to which the animals are dually assigned for a designated period of time. For more details on the procedures, see the IACUC policy titled “Dual Protocol Assignment.”

1. Describe the intersection of the two protocols including a chronological summary of all procedures during the dual assignment period. Attach a copy of flowchart (each primary and secondary flow chart must include reference to the other protocol):

Note: If Secondary Protocol includes any major surgeries, dual assignment will not be approved.

Approval of protocols that use animals assigned to other protocols binds the principal investigator into an agreement that coordinates all animal sampling and procedures with the corresponding principal investigator, so that all procedures follow the guidelines by relevant governing agencies and the IACUC.

1. Indicate the time period of use for dual assignment.

Estimated start date:

Estimated end date:

1. Indicate the number of animals to which dual assignment will apply:

☐All animals in Primary Protocol, or

☐Specific Animal Numbers (provide number here):______

I certify that I have reviewed the secondary protocol and agree that the activities do not interfere with the scientific validity of the experimental results, the sampling schedule or sampling limits, or other aspect of the primary protocol. I have read and will comply with the IACUC policy on dual assignment of animals, and will amend my protocol if necessary. I will be responsible for signing the sample request form for the secondary protocol.

______

Primary Protocol PI Signature Date

I certify that I have reviewed the primary protocol and agree that the activities of the secondary protocol do not interfere with the scientific validity of the experimental results, the sample schedule or sampling limits, or other aspects of both protocols. I have read and will comply with the IACUC policy on dual assignment of animals.

______

Secondary Protocol PI Signature Date

______

PARC/LARC approvalDate

Dual Protocol Assignment Request Form – 11.18.2013

Page 1 of 2