ANIMAL USE PROTOCOL AMENDMENT FORM by yoursovain

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									                                 ANIMAL USE PROTOCOL AMENDMENT FORM

     Due to signature requirements this form cannot be sent via email. A typed hard copy must be sent to
     Ms. Jenny Whitlock CA 1094.

     Type your response in the highlighted areas.
     Principal Investigator:
     AUP Number(s):
     AUP Title(s):

     What type(s) of changes in the protocol are being proposed? Mark all that apply.
        Change/Add title/funding agency
        Change in personnel
        Change PI
        Number of animals < 10%
        Number of Animals > 10%
        Change in procedure (non-surgical)
        Change in surgical procedure
        Change in anesthesia or analgesia
        Euthanasia method
        Add species/strain and/or request inhouse breeding (breeding addendum must also be submitted)
        Change in emergency contact person

1.
     Add title:
     Change title:
     Add funding agency:


2. Delete the following Personnel




     Add the following Personnel:
     Do not submit this form unless the person you are adding has completed the following:
         The Occupational Health and Safety Enrollment Form
         The LATA On-line Training – Modules Required: The Occupational Health and Safety
            Module, Laboratory Animals, and Species Specific Module
         Barrier Training (if applicable)
     Name            Is he/she        Techniques/        Species     Level of Experience:
                     enrolled in      Procedures to be               Approx. number of times you have performed the
                     MCG’s            performed                      procedure in this species
                     Occupational                                    None           Limited           High
                     Health and                                      (<5)           (e.g. 5-20)       (e.g. >20)
                     Safety Program




     B. For individuals that don’t have experience or who have limited experience/training, who will do
        the training?




     C. What will be done for training? Check one
        Personnel will be trained under the direct supervision of the Principal Investigator until the
        personnel listed above can competently and professionally perform ALL procedures in
        which they will be involved as described in this Animal Care and Use Protocol without
        supervision
        Other training plan (provide specifics)




3. Change in number of animals
    Species Strain         Number of animals               Additional number of animals needed for the
                           originally approved             remainder of this project




   A. Justification for additional animals. Please explain in detail the reason additional animals are required
   (e.g. the number of animals approved on a protocol may need to be adjusted due to unforeseen
   problems, unanticipated results, changes in the research direction, etc)




4. Adding Species
    Species Strain             Number of animals         Source of Animals
                               Requested for the
                               remainder of this project




   A. Justification for adding species. Please explain in detail the reason for using an additional species.




5. Change in non-surgical procedures.
   Add/modify procedures. Describe in detail how the procedure fits into the scope of the project and who
   will be performing the procedure(s) and their experience. Note: If the procedure(s) change the
   pain/distress to a higher classification than you were originally approved then a new Animal Use Protocol
   must be submitted to the committee.
     Add/modify survival surgery procedures that will not increase the pain/distress classification.
     Describe in detail how the procedure fits into the scope of the project and who will be performing the
     procedure(s) and their experience. Note: If the procedure(s) change the pain/distress to a higher
     classification than you were originally approved then a new Animal Use Protocol must be submitted to the
     committee.




     For additions, check the following
          No pain or distress
          Momentary or slight pain or distress
          Pain or distress relieved by anesthesia, analgesia, or sedation
          Pain or distress that will not be relieved by drugs


     Post procedure monitoring will be:
          As described in approved protocol
          Other. Please explain

     I certify to the best of my knowledge, the new procedure(s) requested in this protocol
     do not unnecessarily duplicate experiments or unnecessarily use animals.

         Yes
         No. Please explain

6. Change in use of Analgesics/Anesthetics. Please describe dose, route and volume




7. Change in method of Euthanasia. Please describe dose, route and volume




8. Change in emergency contact person. Please provide name and phone number (after hours)




     ALL AMENDMENTS MUST BE APPROVED BY THE IACUC PRIOR TO IMPLEMENTATION.

     Principal Investigator’s Signature: __________________________________Date: _____________
         ___ The changes proposed are considered minor and approved administratively.
             The changes may be implemented and this form will be filed with the original protocol.

       ___    The changes proposed are considered major and were reviewed by the full IACUC Committee.
              The changes may be implemented and this form will be filed with the original protocol.




Approved
Signed                                       Date: __________________
       (Attending Veterinarian)

       ___________________________          Date: __________________
       (IACUC CHAIRMAN)




                                                                                                      3/2008

								
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