The University of Texas at E Paso Animal Care and Use Committee

**Below for IACUC Office Use**

ANNUAL PROGRESS REPORT/RENEWAL REQUEST FORM /

Date Received:

Date Approved:

Database:______
Protocol No:
Principal Investigator (s):
Project Title:
Department(s):
Telephone: / Fax: / Email:
List any attachments here: / Change in Procedure(s) or Numbers Amendment Request Form
Change in Personnel Amendment Request Form
Other:

Please mail, bring, or fax (915-747-6063) a signed copy of this form to the IACUC Office, Burges Hall, Room 408.

Completed activities to date (Verify completed activities and/or specific experiments/aims were conducted in accordance with the approved protocol. If there was no activity to date, state that.):
Progress summary (Briefly describe progress during the past year. This summary should define the current status of the project in a way that reveals the benefits or understanding gained from the use of animals and the reasons continued animal use is necessary to achieve the scientific or educational objective.):
Animal use(List all species that were approved for use, regardless of whether or not a given species actually was used. For each species, enter the total number of animals approved for use and the actual number of animals used to date. Be sure to include species and numbers that may have been added to the protocol by approved changes. The number of animals used should not exceed the number approved. If it does, a detailed explanation of the circumstances thatresulted in the overuse of animals must be attached. If the number of animals used is below the planned number, explain the disposition of unused animal, e.g., transferred, not bred, not ordered, etc.):
Species
(common name) / Number Approved / Additional Number Approved / Total Approved / Total Used
Adverse events(List all events that negatively influenced animal health or well being during the past year. Include unexpected surgical complications, infections, drug reactions, mortality, humane endpoint intervention, infection, failure of surgical wound to heal, greater anesthesia needed, bleeding at injection site, unexpected animal death, and other such events that were not predicted and planned for within the approved protocol. If none were encountered, that should be specified.)
Corrective measures(If adverse events were encountered, describe the measures that were taken to reduce or eliminate their effects on animal health or well being. Include an assessment of the effectiveness of those measures.):
Expected: / 1)*
Resolution (corrective measures): / 1)
Unexpected: / 1)
Resolution (corrective measures): / 1)
* Continue numbering events if necessary.
Amendments:
  • To amend procedures or change the animal numbers, please complete and attach the Change in Procedure(s) or Animal Numbers Amendment Request Form.
  • To add personnel, please complete a Change in Personnel Amendment Request Form.

List the names of current protocol workers:
List the name of protocol workers that should you wish to remove from the protocol:

PI Signature:Date:

APPROVAL:

Attending Veterinarian certification of oversight review, and consultation on proper use of anesthetics and pain relieving medications for any painful procedures:

Name: / Signature: / Date:

Certification of review and approval by the Institutional Animal Care and Use Committee:

Name: / Signature: / Date:

New Form 10/2007

Annual Progress Report/Renewal Request Form, Page 1

A- ______