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                                   Department of Psychology
                                  Animal Utilization Protocol
                             Application for Minor Ethics Approval

1       Investigator Data:

Student Name:

Date of Animal Care training course:

Supervisor:

Project Title:


Does this project fall under a research program that was previously approved by the Queen’s
University Animal Care Committee?

If yes, attach a copy of the protocol and provide the following details.

Principal Investigator:

Project Title:


Protocol Number:

Note: If the proposed project has not been approved by the Queen’s University Animal
Care Committee, an Animal Utilization Protocol must be submitted and approved prior to
beginning the research.

2       Emergency Contacts:

Name:                                  Phone Number:

Name:                                  Phone Number:


3       Approval:

Reviewed by:

Signature:

Date:
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                                         Study Outline

1         Animals:

Species:

Strain:

Gender:

Number:

2      Proposed Procedures:
Provide description of surgical procedures, immunizations, behavioural tests, drug
administration, method of disposition, etc.




3       Category of Invasiveness:
Refer to the Canadian Council of Animal Care; Categories of Invasiveness in Animal
Experiments.


4      Overall Objectives of study:
Potential benefit to health and/or advancement of scientific knowledge.
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5      Restricted Procedures:
Will the project involve any of the following? (Yes or No)

Food Deprivation

Water Deprivation

Pain and/or distress

Administration of neuromuscular blocking agents/anesthesia

The use of     radioisotopes

               carcinogens

               infectious agents

               transplantable tumours

               transgenic species


6       Justification:
If you have responded yes to any of the questions in Section 5, justify the necessity of including
this procedure in your protocol.

				
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posted:7/30/2012
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