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					    University of North Carolina at Asheville
    INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE
           ASSURANCE OF ANIMAL CARE FORM

The UNCA 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 UNCA Faculty can be directly responsible for projects involving vertebrates. 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:




UNCA IACUC Form 6/3/05                              1
    University of North Carolina at Asheville

    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. RESEARCH STAFF
Principal Investigator or Course Director:

Phone #:                                         E-mail:

College/Department/Institute:




UNCA IACUC Form 6/3/05                            2
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:
UNCA or outside University/Agency affiliation:
Completed UNCA 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:
UNCA or outside University/Agency affiliation:
Completed UNCA 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:
UNCA or outside University/Agency affiliation:
Completed UNCA 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):




UNCA IACUC Form 6/3/05                                3
II. THE ANIMALS & PROCEDURES USING ANIMALS
    ANIMAL SPECIES AND STRAIN        NUMBER USED AT       TOTAL        SOURCE OF ANIMALS
                                        ONE TIME        (PER YEAR)




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

        IFYES 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.




UNCA IACUC Form 6/3/05                        4
PURPOSE OF STUDY: Incomplete or unanswered questions will cause this Assurance to be returned.

A) PURPOSE OF ANIMAL USE            RESEARCH                       TEACHING            DIAGNOSTIC

B) TYPE OF EXPERIMENT               NON SURVIVAL                   SURVIVAL            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.]




UNCA IACUC Form 6/3/05                               5
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:

             a. unnecessarily duplicate previous research,

             b. that procedures are the most refined possible,

             c. 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.




UNCA IACUC Form 6/3/05                               6
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? Yes         No

        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, and
preventative 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.]




UNCA IACUC Form 6/3/05                                  7
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.

YES     NO

                 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 animals mobility or
UNCA IACUC Form 6/3/05                                8
                 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.]

UNCA IACUC Form 6/3/05                               9
                 CHEMICAL CAPTURE OF FREE-RANGING VERTEBRATES (IN ADDITION TO OR OTHER THAN
                 USE OF PHYSICAL CAPTURE TECHNIQUES) [Describe equipment used including method of
                 approaching the animal (i.e. helicopter, snowmachine, etc.) projectile systems for
                 administering drugs, etc. If physical capture techniques are also employed please
                 describe them above. See “Administration of Anesthetics” above for additional
                 requirements for describing the drugs used.]

                 ANIMAL TRANSPORTATION [Describe how animals are procured and transported to the
                 animal housing facility or between sites in the field. If animals are transported on
                 campus, describe method used and care that is provided to the animals while in
                 transport. If translocating or transporting wildlife or game species please provide full
                 details.]

                 BEHAVIORAL/OBSERVATIONAL TESTING OR STUDY (WITHOUT SIGNIFICANT RESTRAINT OR
                 NOXIOUS STIMULI) [Includes most field studies conducting basic observational research.
                 Describe procedure.]

                 NON-SURVIVAL SURGERY      [If YES, complete Animal Surgery Information]

                 SURVIVAL SURGERY [If YES, complete Animal Surgery Information]

                 ARE  YOU PLANNING ANY OF THE FOLLOWING? IF SO, PLEASE CONTACT THE          IACUC    FOR
                 INSTRUCTIONS.

                 ADMINISTRATION OF PARALYTICS

                 ADMINISTRATION OF INFECTIOUS ORGANISMS

                 ADMINISTRATION OF RADIATION TREATMENT

                 ANTIBODY PRODUCTION (POLYCLONAL OR MONOCLONAL)

                 BEHAVIORAL TESTING (WITH SIGNIFICANT RESTRAINT OR NOXIOUS STIMULI)

                 DEATH AS AN ENDPOINT (LD 50 or similar studies)


                 WILL ANY PROCEDURES CAUSE MORE THAN MOMENTARY OR SLIGHT PAIN/DISTRESS?
                 [Complete the following and describe measures taken to alleviate adverse effects. What
                 methods are used to estimate presence or degree of pain/distress? If no measures are
                 taken you must PROVIDE SCIENTIFIC JUSTIFICATION.]
                         EXPECTED PAIN/DISTRESS LEVEL     NIL    LOW       MODERATE          HIGH

                         DEFINITIONS FOR PAIN LEVELS CAN BE FOUND AT
                         DISCOMFORT IS EXPECTED         DURING PROCEDURE

                                                        POST PROCEDURE - DURATION:




UNCA IACUC Form 6/3/05                               10
 III. BIOHAZARDS
WILL YOU HOUSE ANIMALS IN AN ANIMAL HOUSING FACILITY OR RELEASE ANIMALS INTO THE WILD AFTER
THEY HAVE BEEN GIVEN AGENTS THAT MAY BE HAZARDOUS TO HUMANS OR OTHER ANIMALS?

            YES           NO

If yes indicate the type of agent:
AGENTS:        CARCINOGENS       ISOTOPES      INFECTIOUS       CHEMICAL           OTHER

LOCATION OF ROOM WHERE ANIMALS WILL BE HELD:

Describe the agent, type of hazard, amount and route of administration, frequency of administration,
route of excretion, anticipated deficit/adverse effects on treated animals, monitoring protocol/schedule
for affected animal. If previously described under animal used procedures please indicate. Rooms, pens,
and/or paddocks must be properly marked and staff informed.



IF USING BIOHAZARDS, YOU MUST ALSO FILL OUT EHS FORM



IV. ANIMAL SURGERY INFORMATION
    Check here if no surgery is planned. If no surgery planned, go to section V.



       SPECIES USED              NUMBER USED             S=SURVIVAL         BUILDING AND ROOM WHERE
                                                                          SURGERY IS PERFORMED (INDICATE
  (ADD ROWS IF NEEDED)                              N=NON-SURVIVAL           IF THIS IS FIELD SURGERY)




PRE-OPERATIVE PROCEDURES/CARE:

a) Have unhealthy animals been exempted from surgery?            YES             NO

     If no, explain the rationale for performing surgery on unhealthy animals.



b) Person responsible for evaluating pre-operative health status of animals.




UNCA IACUC Form 6/3/05                              11
c) Provide a brief description of all pre-operative procedures and care. [Including withholding of
food and water, pre-operative antibiotic/therapeutic drug/fluid administration (agent, dose in mg/kg),
route of administration, frequency, duration of treatment, preparation of surgical site (e.g. clipping, use
of antiseptic scrub/solution, etc.)]



ANESTHETIC PROCEDURES:

a) Provide a brief description of anesthetic procedures. [Describe agent, dose (i.e. mg/kg or % if by
inhalation), route of administration, expected duration of anesthesia, monitoring procedure to evaluate
depth of 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.]



b) Identify the individual(s) performing and monitoring anesthesia.



SURGICAL PROCEDURES:

a) Provide a brief description of all surgical procedures to be performed. [Include site of incision,
procedures performed, anticipated duration of procedure, method of wound closure including type and
size of suture/staples.]



b) Describe procedure employed to ensure aseptic technique is maintained through out surgical
procedure. [Describe sterilization method used for instruments, equipment and supplies; indicate the
use of sterile gloves, gowns, drapes, mask, cap, sterile implants, sterile suture/closure material. Since
gowns are not required for rodent surgery please indicate the clothing to be worn during surgery. If
same surgical instruments are used for multiple animals (i.e. rodents), describe how the instruments are
managed to assure continued sterility.]



c) Identify all individuals performing surgery.



POST-OPERATIVE PROCEDURES/CARE:

a) Provide a brief description of all post-operative procedures and care. [Include criteria to assess
animal pain and the need for analgesics, type of post-operative analgesics (describe agent, dose, route
of administration, frequency, duration of treatment); techniques used to ensure maintenance of normal
body temperature in the animal; incision care, monitoring and time of suture removal; catheter or long
term care of any chronically instrumented/implanted animals, monitoring and time of removal;
bandage/dressing monitoring and changing schedule.]
UNCA IACUC Form 6/3/05                              12
b) If post-operative analgesics will not be used, PROVIDE SCIENTIFIC JUSTIFICATION.



c) Describe arrangements for post-operative monitoring of animals, the individual(s) responsible
for performance of monitoring, including after-hour, weekend and holiday care.



d) Describe the use of any antibiotics or other therapeutic drugs. [Describe agent, dose (i.e. mg/kg,
IU/kg), route of administration, frequency, duration of treatment.]



e) If this surgical procedure induces a disease or other functional alteration, describe any
anticipated adverse effects and deficiencies, monitoring protocol/schedule for animals, animals’
degree of tolerance to disease/functional deficit.




MULTIPLE SURGERIES:

Will animals be subjected to more than one (1) survival surgery?

 YES                     NO

If yes, provide scientific justification and explain how surgeries are related. [A major operative
procedure is one that enters a body cavity. You must provide additional justification to perform multiple
major operative procedures on one animal. Removal of telemetry devices is an acceptable reason.]




V. EUTHANASIA AND DISPOSAL
ALL METHODS OF EUTHANASIA MUST FOLLOW THE AVMA PANEL ON EUTHANASIA (Journal of the
American Veterinary Medical Association Vol. 218, No.5 March 1, 2001, pages 669-696. Accessible
from the IACUC web site http://www.uaf.edu/iacuc/). ANY DEVIATIONS MUST BE SCIENTIFICALLY
JUSTIFIED.

PLEASE DESCRIBE THE METHOD PLANNED. IF BY CHEMICAL AGENT YOU MUST IDENTIFY THE COMPOUND
AND SPECIFY THE DOSE (mg/kg) AND ROUTE OF ADMINISTRATION. PHYSICAL METHODS (CERVICAL
DISLOCATION, DECAPITATION) MAY BE USED ONLY AFTER OTHER METHODS HAVE BEEN EXCLUDED AND
WHEN SCIENTIFICALLY JUSTIFIED.




UNCA IACUC Form 6/3/05                             13
DESCRIBE METHOD USED TO ENSURE THE ANIMAL WILL NOT REVIVE (e.g. removal of heart, induction of
bilateral pneumothorax, observation of rigor mortis, etc.)



EVEN IF YOU DO NOT INTEND TO EUTHANIZE ANIMALS AT THE COMPLETION OF YOUR PROJECT, A METHOD
OF EUTHANASIA SHOULD BE LISTED IN CASES OF EMERGENCY OR YOU ARE UNABLE TO SELL/TRANSFER
THESE ANIMALS.




IF ANIMALS ARE NOT EUTHANIZED PLEASE INDICATE THEIR DISPOSITION [e.g. transferred to another
project/class - indicate new project, IACUC # and investigator. OTHER - please describe.]




UNCA IACUC Form 6/3/05                          14
VI. 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 Director                        Date



VII. APPROVAL:
        Final Approval - Chairman, Institutional Animal Care and Use Committee

                                                                          Date




UNCA IACUC Form 6/3/05                               15

				
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