IACUC Annual Review form

A principal investigator is required to submit a brief protocol summary annually.

Protocol title(Required)

Principal Investigator's name(Required)

Note: Use this report only to provide the annual or final report of protocol activity. Do not use this form to request changes in the original protocol. For such requests, use the NAU IACUC Modification Request Form.

I. Animal use

The investigator should report the number of animals used in this protocol since the last annual report. Include species, common name, sex, and USDA pain category.

Species(Required)

Common name(Required)

Sex(Required)

Number(Required)

USDA Pain Category(Required)

II. Project summary

In lay terms, provide a brief synopsis (1 page or less) of study activities and results for the past year.(Required)

III. Problems encountered

Describe any health problems, accidental deaths, or other animal welfare issues encountered in this reporting period for this study and describe how those problems were addressed.(Required)

IV. Personnel training

Please list all current approved personnel. Identify those personnel who have left the research program. As a reminder, personnel must return access cards and entry keys to the IACUC office when leaving the research program.(Required)

V. Approvals and certifications

Signature(Required)

By checking this box, I certify that, to the best of my knowledge, the information included herein is accurate and complete. I understand that should the conduct of the protocol require a material change from that stated herein, approval by the IACUC is required before I may proceed to implement the change.

Date(Required)

Name

This field is for validation purposes and should be left unchanged.

ON THIS PAGE

I. Animal use

II. Project summary

III. Problems encountered

IV. Personnel training

V. Approvals and certifications