IACUC Assurance of Animal Care Form

University of Alaska Anchorage

Institutional Animal Care and Use Committee

assurance of animal care fORM

The UAA Institutional Animal Care and Use Committee must approve all research, teaching and diagnostic projects using live vertebrates prior to commencement of activities or acquisition of animals. Submit the completed Assurance of Animal Care form to the Chair of the IACUC Committee

Note: When completing this form do not "refer to" your proposal, lab manual, project reports, previous publications, etc. These documents rarely have the necessary information to evaluate your animal use protocol(s). If appropriate you may attach supporting information.

We only accept electronic submissions (supporting information may be submitted separately if not in electronic format). Send e-mail submissions to the IACUC committee chair. Please put “IACUC Animal Care Form” on the subject line of your e-mail and indicate in the text of your e-mail that you are submitting an Animal Care Form as an attached document. Always check to be sure that we received the document and remember: you must still sign the declaration page. This may be done in person or you may print off the declaration page, sign it and send it to us by campus or regular mail. Your protocol will not be approved until complete.

If you are unclear as to what is required to complete this form please contact the IACUC for instruction.

This protocol will be valid for 12 months after approval and must be kept current, especially with respect to new methods or techniques as they evolve (see Appendix listing significant changes to animal use protocols). Please obtain the required forms for submitting a modification. As stipulated in the Animal Welfare Act and Public Health Service Policy, this protocol may be renewed annually by the PI for a maximum of 2 renewals. You will receive an annual review form from the IACUC for 2 years and on the third anniversary of this Assurance you will be notified of its termination. At this time you will need to submit a new protocol for review. Following approval, an IACUC number will be assigned to this protocol. All lab animals and captive wildlife used under this Assurance of Animal Care Form must be identified with the assigned IACUC number by using cage cards, door cards, or some ready method of identifying pens or paddocks with this Assurance.

Only UAA Faculty and Research Associates can be directly responsible for projects involving vertebrates. Graduate students and staff may fill out this form but their immediate supervisor is responsible for the protocol and must be listed as the Principal Investigator and sign the declaration page.

For more information: http://www.uaa.alaska.edu/iacuc/

University of Alaska Anchorage

Institutional Animal Care and Use Committee

assurance of animal care form

Office Use Only:

IACUC Protocol No USDA Pain Classification: C / D / E

(circle one)

Date Received: Approval Date:

Renewal Month: First Annual Renewal Date:

Second Annual Renewal Date:

Title of Project/Course (Include Course Number):

NEW SUBMISSION

THREE YEAR MANDATORY RE-WRITE

MAJOR MODIFICATION TO EXISTING PROTOCOL #

Approx. Starting Date: Completion Date: Ongoing

Name of Funding Source Grant Deadline (if applicable):

I. DECLARATION: The information on this Assurance of Animal Care Form is an accurate description of my animal care and use protocol(s). All people using animals have been properly trained to use appropriate methods and have read and agree to comply with this protocol. All individuals working under this Assurance will comply with the procedures and methods outlined in NIH Guide for the Care and Use of Laboratory Animals, as well as PHS Policy, The Animal Welfare Act, and applicable University Policies. All field research will be carried out in accordance with the principles outlined in Acceptable Field Methods of Mammalogy, Guidelines for the Use of Wild Birds in Research, Guidelines for the Use of Fishes in Field Research, and/or Guidelines for the Use of Live Amphibians and Reptiles in Field Research. All use of animals in agricultural research or teaching will comply with the procedures and methods outlined in the Guide for the Care and Use of Agricultural Animals in Agricultural Research and Teaching. All work proposed herein is the most refined possible to avoid or minimize discomfort, distress, and pain to the animals; does not unnecessarily duplicate previous experiment; and non-animal alternatives have been considered.

Principal Investigator or Course DirectorDate

II. APPROVAL:

Final Approval - Chairman, Institutional Animal Care and Use Committee

Date

III. RESEARCH STAFF

Principal Investigator or Course Director:

Phone #: E-mail:

College/Department/Institute:

Personnel Qualifications:

List all personnel involved with the animal component of this project and their qualifications. You should include principal investigator, co-investigator, research technicians, teaching assistants, graduate students, undergraduate students, student hires, etc. Indicate the most recent date these individuals have completed the web-based formal training course: Principles of Humane Animal Care and Use. Add as many personnel to this list as necessary. Please duplicate sections as necessary.

Name: Degree(s):

Role(s) on Project:

UAA or outside University/Agency affiliation:

Completed UAA Formal Training? YES NO

If No please indicate anticipated date of completion or other source of training in past 5 years

Brief Outline of Experience (limit to how it applies to your activities on this project):

Name: Degree(s):

Role(s) on Project:

UAA or outside University/Agency affiliation:

Completed UAA Formal Training? YES NO

If No please indicate anticipated date of completion or other source of training in past 5 years

Brief Outline of Experience (limit to how it applies to your activities on this project):

Name: Degree(s):

Role(s) on Project:

UAA or outside University/Agency affiliation:

Completed UAA Formal Training? YES NO

If No please indicate anticipated date of completion or other source of training in past 5 years

Brief Outline of Experience (limit to how it applies to your activities on this project):

IV. THE ANIMALS & PROCEDURES USING ANIMALS

Classification of Project:

Research/teaching on vertebrates in a field setting only

Research/teaching on vertebrates housed in a laboratory or captive setting only

Use of vertebrates in both a field and housed in a laboratory setting

Agricultural research

Is this protocol being reviewed by another Institution’s or agency’s IACUC?

yes no

If yes please provide us with a copy of the final letter of approval and a contact person for that committee

Permits:

permits are needed:Yes No

list permits needed

The PI must append a copy of all relevant permits (ADF&G, USF&WS, MMPA, CITES, USDA import/export, etc.) to this assurance of animal care form prior to starting this project.

Purpose of Study: Incomplete or unanswered questions will cause this Assurance to be returned.

A) purpose of animal useresearchteachingdiagnostic

B) type of experimentnon survivalsurvival both

C) Objectives: In 500 words or less, how would you explain to a non-scientist, the specific objective(s) of your project or class? Explain how your proposed animal use procedures allow you to accomplish these objectives. Please explain how this project benefits human health, animal health and/or how this project will provide a return of knowledge and understanding applicable to the species or biological process under study.

D) Justify the following:

Rationale for the use of animals: [Why must animals be used rather than cell cultures, computer models, cadavers, etc.? If this is a field study you may indicate that you are evaluating certain biological features of a species or population.]

Appropriateness of species to be used: [Briefly describe the biological characteristics of the animal species selected that justifies its use in the proposed study/class. Cost should not be used as a justification, except as a means to choose among species that are equally well-suited for the proposed project. If this is a field study please explain why this work will benefit the particular species or population under study.]

Basic scientific methodology/research design and number of animals to be used: [How did you determine the number of animals required? When possible include a statistical power justification of the group size(s) or a yield of tissue needed per animal. For complex studies, including a flow chart or table showing group sizes, time frame, etc. may be helpful in understanding how the total number of animals was determined. Basic scientific methodology and research design goes here but details of animal use procedures must go below. Be sure to include a description of control groups.]

Replacement, Refinement and Reduction:

1) The Animal Welfare Act and Public Health Service Policy require that the principal investigator consider alternatives to procedures that may cause more than momentary or slight pain or distress to the animal. Have you done so?

Yes No

2) You must provide a written narrative description of the methods and sources used to determine that this work does not:

1. unnecessarily duplicate previous research,
2. that procedures are the most refined possible,
3. that you have considered alternatives to procedures that may cause more than momentary or slight pain or distress to the animal.

This narrative description must provide details on the methods you used and sources consulted to determine that alternative procedures are not available or acceptable. Examples of sources might include a literature search, review of scientific journals, discussion with colleagues, etc. As a minimum, the database(s) used to search the literature and keywords used MUST be listed and results noted or attached.

Study Areas:

A) Field Study: [If applicable, please describe the location of your field study with anticipated boundaries. If animals are to be held for brief periods you must describe the temporary holding facilities that you intend to use, the time the animals will spend here, and your animal care protocol. If field surgery is planned you must also complete the section on Animal Surgery Information.]

B) Housing of Animals: [Complete section B only if applicable]

Will animals be taken to a laboratory/study area outside the established animal housing facility?

YES NO

If yes, list the building name: and room number:

List procedures to be performed in this area:

Will animals taken to this area be maintained for longer than 12 hours? YesNo

If yes give the total length of time animals are to be held and explain why they must be maintained in this area rather than being returned to the animal facility [If an animal is maintained in an area for more than 12 hours it will be classified as a satellite facility and is subject to IACUC and possibly USDA inspection.]

C) Husbandry: [If animals are to be held for > 12 hours, provide details of their care. Information to be covered include feeding regime and amount, cage design and cleaning schedule, methods for ensuring health, well being, and safety. Details of any veterinary care should be in the next section]

Veterinary Care of Animals: [Indicate the individual / organization you are using to provides veterinary support and care to live vertebrates used in research and teaching. Please provide the name(s) of veterinarian(s) providing medical care to your animals (emergencies, illness, preventive medicine). This section may not be applicable to field studies unless invasive procedures are planned. Captive housing of fish does not necessarily require a veterinarian; however, you must provide a description of your fish health program and identify the diagnostic facility to be used in case of a fish mortality event. Do not leave this area blank! If it is a field study not requiring veterinary care then type in “Not Applicable” – you will be notified if the committee disagrees.]

Animal Use Procedures:

check yes or no to each question (hint: double click on the box) and add the needed information below the appropriate section. Expected information is explained in italics. Some protocols may require information not specifically listed here. Please ensure that all information needed to evaluate your protocol is provided. If you are planning activities not listed below please add a section to account for all procedures expected to be done on animals.

YesNo

Blood Sampling [Describe techniques, sites of collection, volumes per sample, frequency of sampling(s), total samples per animal, length of time animal maintained for sampling, indicate the % blood loss per week based on the animal’s body weight and, if applicable, describe how animal(s) will be monitored for anemia.]

Urine/Feces Sampling (from live animals only) [Indicate method and for all methods indicate the length of time the animal is maintained for sampling(s). For metabolic cages, describe dimensions of cage and time animal is housed in cage. For catheterization describe frequency of sampling(s). For cystocentesis describe technique, frequency of sampling. For manual expression describe technique and frequency of sampling(s).]

Other Body Fluids and Tissue Sampling (from live animals only) [Indicate the type of substance, e.g. CNS fluid, abdominal fluid, bone marrow; method of collection; volumes per sample; frequency of sampling(s); length of time animal is maintained for sampling; total samples per animal.]

Necropsy or Tissue Collection from Euthanized or Kill Trapped Animals [If the sole purpose of euthanizing or kill trapping is to obtain biological samples from the animal please indicate what you are collecting for your study. Ensure that this matches objective statements and that the section on euthanasia and/or wildlife trapping is complete. Ensure that all other appropriate sections are completed. ]

Special Diets [Will food items other than standard commercial chows, feed plant formulations/supplements, hay/grasses, etc. be used? If yes, describe diet, duration of use, anticipated nutritional deficit/adverse effect, weight monitoring of animal(s), amount of weight loss that will be allowed, monitoring protocol/schedule for effects.]

Food and/or Water Deprivation [Describe duration, frequency of deprivation, reason(s) for deprivation, monitoring protocol of animal(s), amount of weight loss that will be allowed, anticipated deficit/adverse effect, monitoring protocol/schedule for effects.]

Application of unusual environmental conditions [Describe condition applied (extended darkness, cold, heat, altitude, etc.) duration, frequency, monitoring protocol of animal(s), anticipated deficit/adverse effect, monitoring protocol/schedule for effects.]

Tagging, Marking, Placement of Indwelling catheters or implants [Describe type, size, duration of use, maintenance and monitoring protocol/schedule. For free-ranging wildlife, please indicate if the tag or mark might affect the animal's mobility or increase the likelihood of predation. If implantation requires a surgical protocol please mark yes to this question and complete the section on Animal Surgery Information. NOTE: INSERTION OF PIT TAGS DOES NOT CONSTITUTE SURGERY SO YOU NEED ONLY FILL OUT THIS SECTION IF YOU ARE USING THIS METHOD OF MARKING]

Administration of Anesthetics [If associated with a surgical procedure please indicate and refer to the Animal Surgery Information section. You are not required to provide this information twice. Describe agent, dose (mg/kg), route of administration, duration of anesthesia, method of monitoring anesthesia; maintenance/monitoring procedures to ensure normal body temperature is maintained in the animal, procedures employed in case of anesthetic emergency over-dose, monitoring protocol to ensure animal’s complete recovery from anesthesia; if by inhalation describe the equipment used and state the method of scavenging waste anesthetic gas/fumes; if injectable agent(s) are not commercially prepared and sterility guaranteed please describe method used to assure the agent’s sterility when injected.]

Administration of Analgesics [Describe agent, dose (in mg/kg), route of administration, frequency, duration of use. If associated with a surgical procedure please indicate and refer to the Animal Surgery Information section.]

Administration of Drugs, Toxins, Reagents, Cells, etc. (other than anesthetics, paralytics, or analgesics) [Describe agent, dose (i.e. mg/kg), diluent, route of administration, list equipment used for administration - e.g. gavage needle, stomach tube, cerebral cannula, venipuncture, etc., frequency of administration, length of time animal maintained, anticipated deficit/adverse effects, monitoring protocol/schedule for effects. State if no adverse effects are anticipated. Describe monitoring procedures to ensure cell lines have been screened for rodent pathogens. If injectable agent(s) or silastic implant(s) are not commercially prepared and sterility guaranteed please describe method used to assure the agent’s sterility when injected. If treatments are applied to an immature egg/embryo will it be allowed to grow into the mature animal state? If YES describe any anticipated effects to the mature animal.]

Use of Controlled and/or Prescription Substances [If obtaining these substances through the UAF Veterinary Services Pharmacy you must contact the Attending Veterinarian – no pharmaceuticals will be dispensed unless their use is described in this Assurance. Irrespective of source, describe arrangements for use, ordering, record keeping, storage, and precautions taken to avoid unauthorized access.]

Vertebrate Handling and Restraint Procedures [Describe method, duration, equipment used, dimensions of equipment if applicable, observation schedule during confinement. Please provide detailed justification and protocol if animals are to be physically restrained for longer than 1 hour at a time.]

Physical Methods of Capturing Wildlife Including Trapping, Snaring, Herding, Baiting, Corrals, or Netting (Includes survival and/or killing techniques) [Describe equipment used, duration of restraint, monitoring protocol/schedule for capture technique used, potential for capturing non-target species, disposition of captured animals. You must provide a protocol for dealing with injured target or non-target animals. If anesthesia or immobilization is also planned please refer to those sections of this form.]