CHARLES STURT UNIVERSITY ANIMAL CARE AND ETHICS COMMITTEE Wildlife Research Application Form Use this form for wildlife research conducted in the field (e.g., surveys) To expedite resolution of any minor issues raised by the ACEC during consideration of your application, please provide a landline telephone contact number appropriate for the duration of the relevant ACEC meeting. Alternatively you are welcome to speak to your application at the meeting. If you wish to address the meeting, please contact the ACEC’s Governance Officer on 6338 6147. Telephone Number: Office Use Only Date Received: / / ACEC Agenda Item No.: __________________ Period of Approval: / / to / / Protocol No.: __________________ Governance Officer, ACEC _____________________________________ Date: __________________ NOTE: This form must be typed. SECTION 1: ADMINISTRATION GIVE THE SCIENTIFIC AND COMMON NAME (AND, IF APPLICABLE, AGE, SEX AND WIEGHT). SPECIES Common Name Scientific Name Age Sex Weight List any specific target species. Where this investigation is part of a student’s research project, their Principal Supervisor must be nominated on this form as the Principal Investigator. Other participants (including students) must be listed in the appropriate section of the form. Name and Designation: WILL THIS WHAT BE USED? OF PRINCIPAL INVESTIGATOR
(DPI) Choose one: Yes No If NO, give a detailed explanation. TRAPS If using Mist Nets, please provide details of experience and training in use. If Pitfall Traps are to be used, the Guidelines for the Use of Pitfall Traps by NSW DPI must be followed. / (Milk, Scales, etc.) Choose one: Yes No If YES, give details. Choose one: Yes No If YES, describe how animals will be transported, over what period of time and what precautions will be taken against cold / heat / stress, etc.,
/ Choose one: Yes No A. If YES, describe what equipment will be used on the animal, how it will be attached, how much the equipment weighs and the impact on the animal. B. How will the equipment be retrieved? Name Qualifications Experience with Species Used If YES, justify why animals need to be housed, and be not be released immediately, and answer questions – C below. A. How will the animals be housed (including whether housed separately or not)? B. What will be the duration of housing? C. What will the animals be fed, and how often, whilst housed?
Principal Investigator:_________________________________________ (Signature) Date: ______________________ (Print Name) Declaration by Head of School / Section (as applicable) I have read this application and am satisfied that the use of animals is justified on scientific, educational or diagnostic grounds. Head of School / Section:_______________________________________ (Signature) Date:_____________________ (Print Name) School / Section:_________________________________________ Submit this form to: The Governance Officer, Animal Care and Ethics Committee Office of Governance and Corporate Affairs CSU in Bathurst Building 1205 Email: CHECKLIST What is happening to the animals? What will be the effects? How will the effects be minimised? Anaesthesia Euthanasia Toxicology Fasting Method Substance Induction – drug, dose, route Location (where procedure will be performed) Volume Route Maintenance – drug, dose, route Expertise of personnel Frequency of treatments / Methods of monitoring anaesthesia and recovery Total number per animal Local and systemic effects Additional support during anaesthesia and recovery (e.g., heat, intravenous fluids) Genetic Manipulation Methods Potential effects Anaesthesia or analgesia Restraint Animal monitoring (methods and Location of induction and recovery areas frequency Endpoint / duration Housing Tumour / neoplasia induction Behaviour Modification Location Method Stimulus (type, duration, frequency) Group housing (stocking rates, sexes) Site Endpoint Isolation Animal monitoring (methods,