INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC) STATUS REPORT FORM FOR TRIENNIAL REVIEW Please note that your existing protocol will expire per the expiration date on your approval memo. If Closing: Please complete and submit this form. At this time, you can submit via email (). If Continuing: Please submit this completed form along with your updated protocol documents, any applicable permits, and CITI completion reports for all personnel. These documents must be submitted to the IACUC for review two months prior to the approval expiration to ensure there is enough time for processing. At this time, you can submit via email (). To Be Completed by the Principal Investigator: Principal investigator (PI) name: PI department: PI Campus Address, Phone and email: Protocol title: IACUC#: Date of initial approval: RECORD OF ANIMAL USAGE Species Total # Approved # Used to Date NATURE OF THE PROTOCOL/STUDY. (Check [ X ] all applicable items.) [ Survival (Chronic) [ Prolonged Restraint [ Inducement of a Disease State ] Study ] ] [ Terminal (Acute) Study [ Neuromuscular [ Inducement of Behavioral ] ] Blockers ] Stress [ Multiple Surgeries [ Antibody Production [ Blood/Tissue Collection ] ] ] [ Transgenic Breeding [ Other - please describe: ] ] PROJECT (Pain) CATEGORY (Check [ X ] for applicable item): B [ ] Animals bred, conditioned, or held for use in teaching, testing, experiments, research, or surgery but not yet needed for such purposes. C [ ] Non-Painful/Non-Stressful D [ ] Painful/Stressful WITH Analgesia/Anesthesia/Tranquilizers
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC) STATUS REPORT FORM FOR TRIENNIAL REVIEW Please note that your existing protocol will expire per the expiration date on your approval memo. If Closing: Please complete and submit this form. At this time, you can submit via email (). If Continuing: Please submit this completed form along with your updated protocol documents, any applicable permits, and CITI completion reports for all personnel. These documents must be submitted to the IACUC for review two months prior to the approval expiration to ensure there is enough time for processing. At this time, you can submit via email (). To Be Completed by the Principal Investigator: Principal investigator (PI) name: PI department: PI Campus Address, Phone and email: Protocol title: IACUC#: Date of initial approval: RECORD OF ANIMAL USAGE Species Total # Approved # Used to Date NATURE OF THE PROTOCOL/STUDY. (Check [ X ] all applicable items.) [ ] Survival (Chronic) Study [ ] Prolonged Restraint [ ] Inducement of a Disease State [ ] Terminal (Acute) Study [ ] Neuromuscular Blockers [ ] Inducement of Behavioral Stress [ ] Multiple Surgeries [ ] Antibody Production [ ] Blood/Tissue Collection [ ] Transgenic Breeding [ ] Other - please describe: PROJECT (Pain) CATEGORY (Check [ X ] for applicable item): B [ ] Animals bred, conditioned, or held for use in teaching, testing, experiments, research, or surgery but not yet needed for such purposes. C [ ] Non-Painful/Non-Stressful D [ ] Painful/Stressful WITH Analgesia/Anesthesia/Tranquilizers
IACUC%20Status%20Request%20for%20Triennial%20Review.docx