UM Animal Care & Use Committee SHORT FORM version 05/22/04
Instructions: This Short Form may be used to:
1. Submit a yearly renewal of a currently approved multi-year protocol (non-competing renewal).
2. Submit the same protocol for a different funding interval.
3. Resubmit an identical protocol to a different funding agency.
4. Submit the same protocol under a new title.
5. Change the Principal Investigator.
6. Add/delete investigators or staff from a protocol.
7. Make minor modifications to the protocol for the next year.
ALL PI's are strongly encouraged to review the ACUC Guidelines Document prior to completing the protocol form. The University of
Miami Animal Care and Use Committee (ACUC) drafted the “Guidelines” in order to clarify the nominal position of the UM
ACUC regarding commonly accepted procedure, and to provide investigators information to aid them in completing the ACUC
animal use protocol forms. The Guidelines document is posted on the ACUC home page. Copies are also available at the ACUC
ALL PI’s are required to read, sign and submit the PI responsibilities document appended to this Short Form.
LABORATORY ANIMAL WELFARE EDUCATION: It is the responsibility of the PI to arrange for all new personnel to obtain
“Core” training in the use of laboratory animals in research, before beginning work on the project. Completion of the “Core”
Course is now required every 3 yrs for all PI’s, Investigators and staff. If you or any of the research team has not taken the web
based “Core” Animal Welfare Course in the past 3 yrs, contact the ACUC Office to arrange for a password to the course site.
Protocols will not be approved until the educational requirement is fulfilled.
OCCUPATIONAL HEALTH AND SAFETY (OH&S) FORM: Please complete the Occupational OH&S Acknowledgement form
appended to the end of the “short form”. The “Short form” will not be approved until all participants have submitted the OH&S
questionnaire. Please also note that there are new requirements for Occupational Health and Safety instruction for PI’s, Co-
investigators and Staff. Protocols will not be approved until the OH&S educational requirement is fulfilled.
Date Original ACUC #
Principal Investigator UM Employee ID #
Original protocol title
Original funding Phone #
COMPLETE PARTS A and B as APPROPRIATE Checklist
Part A. COMPLETE A1-A6
Annual Animal Use Survey COMPLETE PART A7, A8, A9
Annual Animal Use Survey ---field studies only. COMPLETE PART A8
Summary Progress Report COMPLETE PART A9
Have there been any changes in the approved procedures since the last ACUC review? Enter
If YES, you must complete Part B.
If NO, print, sign and submit this “Short Form” to the ACUC office by email
Part B. MODIFICATIONS
Change in animal number COMPLETE PART B1
Change in animal species COMPLETE PART B2
Minor change in procedures COMPLETE PART B3
Alternatives to a potentially painful procedure COMPLETE PART B4
Occupational Health and Safety Form All new Study Participants
UM Animal Care & Use Committee SHORT FORM version 05/22/04 Page 1/7
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PART A. Use Part A of this short form to: (Choose as many as apply)
A.1. Submit a Non-competing Renewal (complete Part A7, A8 and A9 below)
Enter Yes/No If "Yes" enter start date Enter new duration
A.2. Resubmit an identical protocol with a different project Title
Enter YES/NO If "Yes" enter new project title below
A.3. Submit the same protocol to a different funding agency
Enter YES/NO If "Yes" enter new funding agency below
A.4. Submit the same protocol for a different funding interval
Enter YES/NO If "Yes" enter new start date Enter new funding interval
A.5. Change in the Principal Investigator
Enter YES/NO If "Yes" enter Name of new PI Experience with the procedures in the animal model
Note: all new PI’s must complete the U of M Core and OHS training.
A.6. Change in Co-Investigator(s) and/or Technical Staff
Add/Delete Enter Name(s) below Experience with the procedures in the animal model
Note: all new Investigators and staff must complete the U of M Core and OHS training.
PARTS A.7, A.8, and A.9 must be completed for all Annual Renewal applications
A.7. Animal Usage: Please provide the ACUC with a summary of your animal use for the past year.
Species (common name) Number Approved Number Used Inclusive Dates
A.8. Field Investigation only. If you are conducting a field study that involves the collection of wild animals, please provide the
ACUC with an update of your animal collection during the past year.
Species (common name) Number Approved Number Collected Inclusive Dates
A.9. Summary. Please provide a brief summary of the ANIMAL work conducted during the past year. What will be done in the
next year? Include a short description of how you have practiced the 3 R’s of animal usage--- Replacement, Reduction and
Part B. MODIFICATIONS TO THE APPROVED PROTOCOL
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Have there been any changes in animal species, usage or procedures since the last ACUC review?
If there are no changes, the PI should sign, date and submit the form to the ACUC.
If you answer “YES” above, complete the appropriate sections of Part B.
B.1. Change the animal species on your approved protocol, with no change in the methods.
Enter Yes/No If "Yes" enter previous species new species
Provide a scientific justification for the change in species:
Have you consulted with a veterinarian regarding the change in species?
Note: If the change in species requires a change in procedures (e.g., anesthesia, euthanasia, pain relief, drug doses, etc.), you
must complete B3 and B4 below
B.2. Change the number of animals on your approved protocol, with no change in the methods.
Enter Yes/No If "Yes" Enter Species No. Approved Additional No.
Provide a scientific justification for the change in the number of animals:
Provide a description of study groups and/or treatment schemes:
B.3. Modify or add a procedure to an existing approved protocol
This part of the form is to be used for minor modifications to an existing procedure. This form is Enter YES/NO
not to be used as a substitute for the New Projects Form (Long Form). If there are any questions
regarding the use of this form, to avoid delays, contact the ACUC Office at 305 243 2311.
Describe the modified procedure(s):
How is it different from the approved procedure?
B.4. Is the new procedure potentially painful / distressful to the animal?
If you answer YES, provide a narrative describing Alternatives to the Potentially Enter YES/NO
Painful Procedures. Include:
A description of the potentially painful/distressful procedures:
A literature search for alternatives to potentially painful/distressful procedures is required. Provide inclusive dates of the
search, date the search was performed, keywords, and databases used. One of the databases used must be an
2. "Alternatives" Database" (See the ACUC guideline document or the training website for links to "Alternatives"
If less painful procedures are identified by the search and you choose not to use them, provide the scientific justification
3 for using a more painful/distressful procedure:
B.5. Will expired drugs or other materials be used in the proposed studies?
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The use of expired antibiotics, analgesic and anesthetics is expressly prohibited by the Animal Enter YES/NO
Welfare Act and PHS policy. Expired diagnostic reagents, drugs and devices may not be used
at the U of M without prior approval by the IACUC. If you plan to use any outdated or expired reagents, materials or devices
please provide a justification for their use. If YES provide justification below:
Responsibilities of the Principal Investigator
The privilege of using animals in research and teaching at the University of Miami is extended to the faculty with the proviso that
such activities will be conducted in accord with all applicable policies, regulations and procedures of the PHS, the USDA and
University of Miami. Please review and check each of the following “Responsibilities of the PI”.
The Principal investigator is:
Required to have a current animal use protocol, approved by the University of Miami ACUC, before any activities involving
live or dead vertebrate animals is begun.
Required to comply with all Federal regulations, laws and policies.
Required to assure that all participants on this protocol will follow the policies set forth in the Guide for the Care and Use of
Laboratory Animals (The Guide).
Required to comply with all University of Miami Policies regarding the humane care and use of animals in research and
Responsible for the conduct of the work and to assure that all co-investigators, technical staff, students and visiting fellows or
collaborators comply with all federal regulations and Institutional policies.
Responsible for assuring that all participants in animal research studies under their supervision are properly trained in the
humane care and use of animals in research and in the procedures used in the current model system according to Institutional
Responsible for keeping the animal use protocol accurate and up to date. PI’s must inform the IACUC when there are changes
in personnel and funding.
Responsible to assure that the work follows the approved protocol. All changes in the protocol or procedures must be reviewed
and approved before the procedure can be implemented.
Responsible for maintaining animal records in a secure but, accessible location. Records must be available at all time for
review by the attending veterinarian, the ACUC, the USDA and/or PHS.
Responsible for assuring that all pharmaceuticals, reagents and devices used in animal research are appropriate for the research
and are within the manufacturer’s expiration date. The use of expired reagents or devices must be approved in advance by the
ACUC. Under no circumstances can expired anesthetics, analgesics or antibiotics be used in either survival or non-survival
surgery. All expired reagents should be clearly marked “expired - do not use” and returned to the DVR for disposal.
Responsible for assuring that all controlled substances are stored in a safe and secure manner.
Responsible for assuring that all animals in the protocol are properly identified and described according to the UM ACUC
Responsible for obtaining approvals from Radiation Safety, Occupational Health and Safety and/or the Recombinant DNA
Committee prior to beginning animal activities regulated by these campus agencies.
As the PI, I agree to assume the responsibilities listed above. Further, as the PI, I agree to adhere to the PHS Policy on Humane Care
and Use of Laboratory Animals, the ILAR Guide for the Care and Use of Laboratory Animals, USDA regulations as defined in the
Animal Welfare Act and its amendments.
Signature of Principal Investigator (P.I.) Date
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University of Miami Occupational Health and Safety Program
The Occupational Health Program at the University of Miami is offered to employees whose work duties involve contact
with research animals and is covered in the policy, Occupational Health Program for Animal Research Personnel
and Procedures Manual. The current components of this program are based on the recommendations of the National
Institutes of Health’s Office of Laboratory Animal Welfare (NIHOLAW) and are listed in the Summary of
Occupational Health Program for Animal Research Personnel. The occupational health services are provided
according to the employee’s animal exposure as well as any infectious agent(s) to which the employee may have contact.
These services consist primarily of a physical exam, laboratory tests, immunizations and medical follow-up after an
Participation in the U of M Occupational Health and Safety (OH&S) Program is mandatory for all users (i.e., PI’s, Co-
Investigators, Staff and Students working on specific research projects) of laboratory animals in research and teaching,
unless you each specifically decline to participate. A written declaration must be filed with the UM OH&S Program
Office. It is the responsibility of the PI to provide co-investigators, staff and associated project students the opportunity
to participate. The level of surveillance and coverage under the program are risked based.
The Consent Form, the Acknowledgement Form (appended), and the Baseline Medical Surveillance Questionnaire
Form must be completed and originals forwarded to EHS. A copy of the Acknowledgement form should be submitted to
the ACUC office along with the short form protocol. In addition, those employees who are required to wear a respirator
at work must complete the Respirator Medical Evaluation Questionnaire. If an employee declines participation, only
the Acknowledgement Form is to be completed. However, if you or any of your staff or collaborators declines to
participate in the OH&S program, the individual will be required to complete a web based tutorial on
Occupational Health and Safety when Working With Laboratory Animals before the protocol will be approved.
You may register for the course at www.miami.edu/UMH/CDA/UMH_Main/1,1770,7432-3,00.html. If you have
questions, please contact Charles F. Gottlieb, Director EHS or Sandra Chen, Employee Health Manager, at (305) 243-
Please indicate the names of new investigators and staff on this project. Please indicate whether they are
participating in the Occupational Health and Safety Program.
OH&S Web-based OHS
Name Department Phone participant training completed?
Note: Please complete the Occupational Health and Safety Program participation listing and submit to the ACUC Office along with
the short form protocol.
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Occupational Health Program for Animal Research Personnel
To be completed by ALL employees having animal contact at work
Section 1: To be completed by Employee
Last name _________________________First name _________________________SS#_______________________
Title_______________________ Date________ Wk phone#________________ Dept________________________
Building ___________________________Room number _______ Locator code __________ Campus____________
Supervisor/PI name_____________________________ Supervisor/PI phone#______________________________
Please initial appropriate area (Answer A or B)
A. ___________ I accept participation in the Occupational Health Program for Animal Research Personnel.
Accepting participation in the program REQUIRES the completion of the following forms:
1. Consent Form for Program Participation
2. Baseline Medical Surveillance Questionnaire
(To obtain these forms go to: www.miami.edu/health-safety , then “Employee Health Office”, then “Workers
Having Animal Contact”).
B. ___________ I decline participation in the Occupational Health Program for Animal Research Personnel.
I understand that I have animal contact and this is a health risk. All the health risks have been explained to me as well as all the
components of the Occupational Health Program. I also understand that there are health risks in declining participation in this program. I
was offered the opportunity to be included in the Occupational Health Program for Animal Research Personnel and decline to do so. I am
given the opportunity to accept participation in this program in the future if I choose to do so.
Reason(s) for declining participation: _____________________________________________________
Suggestion(s) to improve the program: _________________________________________________________________________
Section 2: To be completed by Supervisor/PI
A. Check the appropriate box
Yes No Individual works in an area identified to require participation in the Hearing
Yes No Individual authorized to wear a respirator (if yes, individual to complete
Respirator Medical Evaluation Questionnaire and forward to EHS)
Yes No Individual has contact with animals
B. List the animal species and/or infectious agent(s) with which employee has occupational contact:
Signature of Employee Date Signature of Supervisor/PI Date
Please return to:
Environmental Health and Safety (R-23), Dominion Tower, Suite 405.Office: (305) 243-3400. Fax: (305) 243-3272
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