<p>DEPARTMENT OF BIOMEDICAL SERVICES HOME OFFICE ADMINISTRATION UNIT</p><p>STRICTLY CONFIDENTIAL</p><p>Local Ethical Review for Project Licence Application</p><p>This form must accompany all applications for a Project Licence (PPL)</p><p>Animal Welfare and Ethical Review Committee Details for PPL Review</p><p>Name of AWERB Date of AWERB</p><p>Applicant Details Surname Given Name(s) Title Project Title BMS Facility for Procedures BMS Facility for Housing (if different than above) Departmental Animal Welfare Meeting Regularly Attended</p><p>Existing Project Licence Details (please provide details for any ‘YES’ selected)</p><p>Do you currently hold a PPL? NO YES Expiration Date</p><p>Have there been any non-compliance events on the PPL (or by PILs working NO YES under the licence) in the last five years?</p><p>Are there any additional conditions (over and above the standard conditions) that have NO YES been applied to the PPL (or PILs working under the licence) in the last 5 years?</p><p>Are there any special measures, requirements, or restrictions imposed by NO YES the local ASRU Inspector for work over the under the licence? </p><p>Applicant Declaration</p><p>I have read and understood the University of Oxford Policy on Animal Use and the Guidance on the Operation of the Animals (Scientific Procedures) Act 1986 and agree to use the University’s Online Supervision & Competency Records (OSCR) System to record training and competency for all work performed under my Project Licence. Initials: Date:</p><p>V2015_09 1 STRICTLY CONFIDENTIAL</p><p>Project Licence Proposal Details 1. Funding Considerations/ Peer Review Please provide details for funding of the available for the work proposed in the project licence. Name of Funding Body Grant No. Amount of Award Dates of award period</p><p>Has this work been peer-reviewed? NO YES</p><p>2.Wild Animal Work</p><p>Does your proposed project involve the use of wild animals, unusual species, or locations NO YES outside the normal laboratory setting? </p><p>3. Consideration of Alternatives 3.1 What non-animal models or other alternatives were considered?</p><p>3.2 Why were these alternatives rejected?</p><p>3.3 What methods and resources were used to consider alternatives (e.g. Alternative databases such as http://altweb.jhsph.edu)?</p><p>2 STRICTLY CONFIDENTIAL</p><p>Project Licence Proposal Details (continued)</p><p>4. Impact on Animals (Harm/Benefit Analysis) 4.1 Please indicate the species and total number of animals to be used under each category Protocol Number(s) Severity Level Species and Number of animals</p><p>Non recovery</p><p>Mild</p><p>Moderate</p><p>Severe</p><p>4.2 For each protocol, indicate what the typical and most extreme experience may be for each animal in terms of the number and type of regulated procedure. Protocol Animal Experience % Experience Number Typical</p><p>Extreme </p><p>Typical</p><p>Extreme</p><p>Typical</p><p>Extreme</p><p>Typical</p><p>Extreme </p><p>Typical</p><p>Extreme </p><p>Please add more rows if needed</p><p>4.3 Please summarise any non-A(SP)A procedures involving living animals that will be part of the same programme of research. E.g Behavioural studies, tissue collection, etc... </p><p>4 STRICTLY CONFIDENTIAL</p><p>Named Training and Competency Officer Review</p><p>Date Name of NTCO</p><p>I have seen the applicant’s original training certificates NO YES</p><p>I can confirm the applicant has completed the relevant and accredited training NO YES required for the Project Licence proposal.</p><p>Additional Comments/Recommendations</p><p>5 STRICTLY CONFIDENTIAL</p><p>Veterinary Surgeon Review Date of Vet/NACWO Meeting Name of Vet</p><p>Comments</p><p>Date </p><p>Post-Revision Comments Date </p><p>6 STRICTLY CONFIDENTIAL</p><p>Named Animal Care and Welfare Officer Review Date of Vet/NACWO Meeting Name of NACWO</p><p>Comments</p><p>Date </p><p>Post-Revision Comments Date </p><p>7 STRICTLY CONFIDENTIAL</p><p>Applicant Response to Comments Date of Vet/NACWO Meeting Please provide a point by point response to the comments raised by the NVS and NACWO. Any revisions to the application in response to these comments should be shown as highlighted/tracked changes in the project licence.</p><p>Date </p><p>8 STRICTLY CONFIDENTIAL</p><p>AWERB Committee Comments and Outcome</p><p>Date of AWERB Meeting</p><p>Name of Representative Was PPL holder in attendance? NO YES</p><p>If application was discussed during meeting, please provide minutes or note relating to the discussion. Alternatively, please provide explanation why the application was approved by circulation or under Chair’s Action.</p><p>Name of AWERB Secretary Date </p><p>9</p>