Zoos Victoria - Animal Ethics Committee Application Page 10

Zoos Victoria Animal Ethics Committee Application Form OFFICE USE ONLY Zoos Victoria project reference no.: Date received: Endorsed by Zoos Victoria Senior Property Managers (Y/N): Date of AEC meeting: Approved by AEC (Y/N, comments):BACKGROUND All scientific procedures using animals must be carried out in accordance with the Prevention of Cruelty to Animals Act 1986, associated Regulations and the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes. These legislative requirements specify that an Animal Ethics Committee (AEC) must verify that the use of animals for research or teaching is justified and adheres to the principles of Replacement, Reduction and Refinement. All proposed animal use must be approved by an AEC before commencing the project. Before completing this application form, investigators should be familiar with the following:  The Australian Code of Practice for the Care and Use of Animals for Scientific Purposes.  Part III of the Prevention of Cruelty to Animals Act 1986 and Regulations 2008.  The Zoos Victoria Code of Conduct for Scientific Research Practice and Occupational Health and Safety procedures. Knowledge of these requirements will assist you in completing this application in a satisfactory manner. The above documents can be downloaded from the Zoos Victoria webpage: www.zoo.org.au/Conservation/Research/Collaborative_research_with_ZVNOTES ON THE COMPLETION OF THIS APPLICATION FORM 1. Applications must be written in plain English. It should be assumed that assessors have either no scientific knowledge or no knowledge of your area of research. Where scientific language is unavoidable, it must be supported by a suitable lay description or a glossary of terms. 2. It is highly recommended that you ask a colleague and a person with a non-scientific background to read the application before it is submitted. 3. You do not need to complete all sections of this Zoos Victoria AEC Application Form if an external institution AEC application/approval letter (or grant application) provides all the required information and accompanies this application. Zoos Victoria - Animal Ethics Committee Application Page 2APPLICATION DETAILS1. Project title:2. This is a: New project  Renewal of an existing project Please provide the previous Zoos Victoria project reference number: Previous project Please provide the previous Zoos Victoria project reference number:3. External institution Animal Ethics Committee (AEC) approval no. (if applicable): PERSONNEL4. Principal Investigator details: Please note that the Principal Investigator should be the project supervisor for undergraduate research projectsTitle First name Surname Qualifications Institution Department Address (work) City/suburb State Postcode Country Telephone number (work) Telephone number (AH) Mobile phone number Fax number Email address5. Associate Investigator(s) details:Name Institution Qualifications/ Phone Email relevant number address experience Zoos Victoria - Animal Ethics Committee Application Page 3Please add further lines as needed 6. Which of the above listed investigator(s) will be responsible for the day-to- day running of the project?7. Who is the Zoos Victoria contact for this project?8. Explain how the qualifications and experience of the responsible investigator and all others directly involved in the project are appropriate to the procedures to be performed and to the species to be used (including any training required prior to commencement of research):9. Please nominate a referee for the above, such as a supervisor at a tertiary institution or workplace: Title Name Institution Phone Email address numberPROJECT SCHEDULEPlease note: the maximum period of approval is 3 years. A new application must be submitted after that time.10. Proposed project start date (dd/mm/yyyy) (do not nominate a date before that of the AEC meeting):11. Expected project completion date (dd/mm/yyyy):PROJECT DESCRIPTIONAvoid the use of jargon where possible. If use is unavoidable, provide brief explanations of the terms used.If the research is a sub-part of a larger or ongoing project that will use previous AEC- approved research methods, include or attach the relevant AEC documents or resources to this application.12. Scientific description 12.1 Background (including key references) Zoos Victoria - Animal Ethics Committee Application Page 412.2 Aims 12.3 Hypothesis12.4 Methods i) Methodology Include a research plan with details regarding transportation, special housing, dose rates of chemical agents, trapping/tracking devices, and methods (if any) of euthanising animals. ii) Number of animals to be used/studiedSpecies (common & Source – Include both Estimated number of scientific name) Zoos Victoria and other animals to be used sources (please specify) from sourcePlease add extra lines as needed iii) Experimental/survey design and data analysis13. How will Zoos Victoria animals be used in this research?PERMITS14. Is the acquisition, holding, or use of the animals subject to any permit, law or regulation of the State or Commonwealth (e.g. protected native or imported)?No Go to Q15.Yes Please attach a copy of the current permit(s) or explain why permit(s) are not attached: Zoos Victoria - Animal Ethics Committee Application Page 5 Zoos Victoria - Animal Ethics Committee Application Page 6ANIMAL WELFARE The purpose of the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes (the Code) is to ensure the ethical use and the humane care of animals used for scientific purposes. The Code emphasises the responsibilities of investigators, teachers and institutions using animals to:  Ensure that the use of animals is justified, taking into consideration the scientific or educational benefits and the potential effects on the welfare of the animals.  Ensure that the welfare of animals is always considered.  Promote the development and use techniques which replace animal use in scientific and teaching activities wherever possible.  Minimise the number of animals used in projects.  Avoid pain or distress for each animal used in scientific and teaching activities.To this end, there is a need in scientific and teaching activities to consider:  The replacement of animals with other methods.  The reduction in the number of animals used.  The refinement of techniques used to reduce the impact on animals.15. Using lay terms, briefly explain the purpose of this project and its potential value or significance:16. Describe the rationale behind the experimental approach being adopted:17. Does the project duplicate work that has been carried out previously?No Go to Q18.Yes Please explain why it is necessary to duplicate the work:18. Have alternatives that totally or partially replace the use of animals been incorporated into this project (e.g. in vitro, computer modelling etc.)?No Provide a list of potential alternatives and explain why they are unsuitable for use in this project:Yes Please describe what alternatives are to be used in this project: Zoos Victoria - Animal Ethics Committee Application Page 719. Justify the number of animals requested in terms of statistical considerations and/or other considerations in the experimental design. Where appropriate, present the numbers in table form:20. Will animals need to be transported from the source location to the location where they will be held for this project?No Go to Q21.Yes Please provide details of transportation and acclimatisation procedures:21. Location of animals during the project Refer to the Code of Practice for the Housing and Care of Laboratory Mice, Rats, Guinea Pigs and Rabbits if using these species i. Will these animals be housed in existing Zoos Victoria facilities appropriate for this species?Yes Go to Q22.No Please describe the following: i. Where will animals be housed during the project? (including shelter provided if housed outdoors) ii. What type of housing will be used? Include details of methods used to ensure that housing meets the specific requirements of the animals being held, and describe any special housing requirements. iii. Will any animals need to be housed individually? If so, explain why, for how long and how the impact of social isolation will be minimised.22. Where will procedures be performed? If animals need to be transported from where they are housed to where the procedures are carried out, provide details of how this will be done:23. Fate of live animals at the end of the project: Return to Wild Captivity (Zoos Captivity (non- Details Victoria) Zoos Victoria facility) Zoos Victoria - Animal Ethics Committee Application Page 824. Does the project involve euthanasia of animals?No Go to Q25.Yes Please justify the use and method of euthanasia in the project:25. Are anaesthetic or neuromuscular blocking agents to be used in the experimental procedure? No Go to Q26.Yes Please specify: Agent Dose Rate Duration Route of Potential Administration side effects26. Will blood or other tissue be sampled?No Go to Q27.Yes Please specify: Type of Volume Tissue/blood Sampling Potential Tissue sampling site Frequency complications27. Will animals experience pain or discomfort related to this project? This must include potential problems that may arise from any of the procedures detailed in the methodology due to unexpected complications (but are not otherwise routinely considered) and should cover all aspects of animal manipulation involved in the study.No Go to Q28.Yes Please explain what steps will be taken to minimise or mitigate pain/discomfort:28. How will animals will be monitored during the project? Describe monitoring methods, frequency and person(s) responsible. Also describe what clinical, behavioural or other signs will be used to indicate that intervention is needed to alleviate an animal’s pain or suffering? Zoos Victoria - Animal Ethics Committee Application Page 929. Who will be responsible for the management of any emergencies, including reporting any adverse incidents to the AEC? Note: unexpected incidents that impact on the welfare of any individual animal or group of animals require an immediate response and must be reported to the Curator immediately if Zoos Victoria animals are involved. All animal welfare incidents must also be reported to the Zoos Victoria AEC.30. Have any of the proposed animals been used for previous research or teaching activities?No Go to Q31.Yes Please provide the AEC project number of the other project(s), describe what was done to the animals previously and justify their use in this project:31. Have any of the proposed animals undergone surgical procedures or have histories of illness that may be relevant to the proposed research activities? Please contact the Senior Veterinarian at the relevant property(s) to obtain this information No Go to Q32.Yes Please provide details of procedures that may have implications on the proposed research: Animal Date of Procedure Type of Procedure32. Are there any additional features of the project that have notable welfare implications for humans or animals?No Go to Q33.Yes Please explain: Zoos Victoria - Animal Ethics Committee Application Page 10DECLARATIONS33. Associate Investigator(s). To be signed by each Associate Investigator.I hereby declare that:1. I have read the research proposal and understand my responsibilities with respect to the research described in this application. 2. I have read the Zoos Victoria Code of Conduct for Scientific Research Practice, and accept responsibility that this project will be conducted in accordance with the Policy and Code.3. I have read the National Health and Medical Research Council Australian Code of Practice for the Care and Use of Animals for Scientific Purposes (The Code). I accept responsibility for implementing the procedures detailed previously, in accordance with the principles contained in The Code and any written conditions specified by Zoos Victoria and/or the Animals Ethics Committee.4. I have read the Prevention of Cruelty to Animals Act 1986 (The Act) and Regulations 2008 (The Regulations). I accept legal responsibility in ensuring that the use of animals for scientific purposes complies with the conditions laid down by The Act.5. I certify that the animals required for this project can be provided, housed and maintained at a standard consistent with the requirements of The Act, The Regulations, The Code and any other condition laid down by the Animal Ethics Committee.Name:Signature: Date:Name:Signature: Date:Name:Signature: Date:Name:Signature: Date: Zoos Victoria - Animal Ethics Committee Application Page 1134. Principal Investigator(s). To be signed by each Principal Investigator.I hereby declare that:1. The qualifications and experience of all personnel conducting research are appropriate to the procedures described in this application.2. I agree to discuss any proposed changes to the procedures and/or personnel described in this application with the nominated Zoos Victoria contact person for this project, and will inform the Zoos Victoria Animal Ethics Committee (AEC) and gain approval before implementing these changes.3. I have read the Zoos Victoria Code of Conduct for Scientific Research Practice, and accept responsibility that this project will be conducted in accordance with the Code of Conduct. I accept responsibility for implementing the procedures detailed previously, in accordance with the principles contained in the Code and any written conditions specified by Zoos Victoria and/or the AEC.4. I acknowledge that Zoos Victoria reserves the right to make changes that may affect this research project and that, although Zoos Victoria will attempt to advise me of changes in advance, prior notice of these changes may not always be possible.5. I have read the National Health and Medical Research Council Australian Code of Practice for the Care and Use of Animals for Scientific Purposes (The Code). I accept responsibility for implementing the procedures detailed previously, in accordance with the principles contained in The Code and any written conditions specified by the specified by Zoos Victoria and/or the AEC.6. I have read the Prevention of Cruelty to Animals Act 1986 (The Act) and Regulations 2008 (The Regulations). I accept legal responsibility in ensuring that the use of animals for scientific purposes complies with the conditions laid down by The Act.7. I will inform the Zoos Victoria Curator (if Zoos Victoria animals are involved) and the Zoos Victoria AEC immediately of any unexpected incidents which result in death, euthanasia, or pain and suffering for the animals used in the project.8. The animals required for this project can be provided, housed and maintained at a standard consistent with the requirements of The Act, The Regulations, The Code and any other condition laid down by the AEC.9. I agree to submit a final report to Zoos Victoria within one month of the approval date elapsing, or (for projects more than 12 months duration) to submit progress reports on an annual basis within one month of the anniversary of the approval period commencing.10. I will provide copies of any reports, theses or publications arising out of the research; and will acknowledge Zoos Victoria’s assistance in any such reports and publications. Zoos Victoria - Animal Ethics Committee Application Page 1211. I will provide information on this research project for the Zoos Victoria website on request.Name:Signature: Date:Name:Signature: Date:OFFICE USE ONLY35. Zoos Victoria AEC Approval:The Zoos Victoria Animal Ethics Committee is satisfied that the qualifications and experience of all personnel conducting research are appropriate to the procedures described in this application, and that animal welfare and other ethical issues have been adequately addressed.Name:Position:Signature: Date:OFFICE USE ONLY Period of Approval: From: To: Principal Investigator notified: Date: Curator/Vet/Director notified: Date: Research Pass Issued: Date: Reports/Publications received: Comments:

Zoos Victoria - Animal Ethics Committee Application Page 10

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