ࡱ> xzwg ,Ibjbj^^ 0V< j< j%UUUUUiii8di !"CCC>lj8  A"$~ EU@> UUCCQ FFFdUCUC F FFFC FjFg 0 Fu'p~u'Fu'UFF X u'Y : ILLINOIS INSTITUTE OF TECHNOLOGY INSTITUTIONAL ANIMAL CARE & USE COMMITTEE (IACUC) ANNUAL REVIEW OF APPROVED PROTOCOL PI  FORMTEXT      Protocol #  FORMTEXT      Dept FORMTEXT      Email Phone  FORMTEXT      Fax  FORMTEXT      Co-PI FORMTEXT      Dept FORMTEXT      Phone FORMTEXT       Project Title   During the past year (check one):  FORMCHECKBOX  The study was not active and no animals were used.  FORMCHECKBOX  The study was active. Number of Animals Approved for this Project:  FORMTEXT       Species:  FORMTEXT       Number of Animals Used to Date:  FORMTEXT       Species:  FORMTEXT       Were there any unexpected mortality, morbidity, disability, infection, or other unanticipated adverse events that negatively affected animal welfare?  FORMCHECKBOX  Yes If yes, describe on a separate page what the events were and the measures taken to alleviate or minimize them.  FORMCHECKBOX  No For the next year (check one):  FORMCHECKBOX  The protocol will not be continued. Close file. Stop here. Sign below and submit.  FORMCHECKBOX  The protocol will continue without change. Stop here. Sign below and submit.  FORMCHECKBOX  The protocol will continue with change. The planned changes are (check applicable boxes ):  FORMCHECKBOX  Minor only. Describe in detail on a separate page the planned minor changes and attach to this form.  FORMCHECKBOX  Major and/or minor. Describe in detail on a separate page the planned changes and attach to this form.  FORMCHECKBOX  Changes in personnel. Describe in detail on a separate page the planned changes in personnel and attach to this form. Provide names and qualifications of all new individuals who will be directly involved in the animal use, including students, residents, interns, etc., even if temporary. Specify the type and length of training or experience using this species and with these procedures that qualifies these individuals to perform the procedures. (DEGREES OR OTHER CREDENTIALS ALONE ARE NOT SUFFICIENT AS QUALIFICATIONS.) If an individual has no experience, please so indicate. Please note: The principal investigator MUST ensure that all individuals have proper training before work begins. The principal investigator MUST contact the campus veterinarian and/or the IACUC office to arrange training if needed for staff.  Principal Investigators Assurance: For active and/or continuing protocols, I CERTIFY that the use of animals has been and/or will be in accord with U.S. Department of Agriculture Animal Welfare regulations (Code of Federal Regulations, Title 9, Chapter 1, Subchapter A, Parts 1, 2, 3), the Public Health Service Policy on Humane Care and Use of Laboratory Animals, the National Research Council Guide for the Care and Use of Laboratory Animals, and the policies established by IIT. I further certify that personnel who will work with animals will be adequately trained, in accordance with the above regulations, to conduct the project in a humane and scientific manner, and that no significant change in this protocol will be implemented without prior IACUC approval. 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A+! DZ!t щN 3RE ]HNB\gU'97=c+g?vG] x8?T~|:bk'c+aV5df4Jho՚ A 0vFE#C(:^1jP c+Ip҉\#&mfê $t\8HA%)c=1^8[rFsѨW+tO$6I^ r"$F1i>.@4jqėgLgjFy 8$3%i!*ɳ<wg/ܣrtBad-;  ނTIENDB`DText23If the PI is not a member of the Duke University faculty, a Duke faculty member must be listed as Co-PI or Sponsor. Both the PI and co-PI or Sponsor must sign the Assurance Statement below.Individual who will ensure that the use of animals is in compliance with applicable laws, regulations, and policies. F1 for more help.D Text5 UppercaseKThe most recent protocol registry number assigned to the approved protocol.2$$If!vh#v#v#v #v#v^:V l40#555 55^/ / / / / / / / / 4f4$$If!vh#v*:V l405*/ 4f4DText7!PI's primary academic department.DText9PI's local telephone number.DText10PI's FAX number.$$If!vh#v#vl #vH#v#v*#vF#vv#v:V l40++++++++55l 5H55*5F5v5/ / / / / / / / / / / / / / / /  4f4$$If!vh#v#vl #vH#v#v*#vF#vv#v:V l490++++++++55l 5H55*5F5v5/ / / / / / / / / / / / / / / / /  4f4$$If!vh#v+:V l4`05+/ 4f4$$If!vh#v+:V l405+/ 4f42DText19The co-PI or Sponsor shares responsibility for ensuring that animal use is in compliance with applicable laws, regulations, and policies. Both the PI and co-PI or Sponsor must sign the Assurance Statement below.Individual who will serve as primary co-PI or who will sponsor a PI who is not a member of the Duke University faculty. F1 for more help.DText241Co-PI's or Sponsor's primary academic department.DText25,Co-PI's or Sponsor's local telephone number.N$$If!vh#v#v#vv#v #v#v:V l40555v5 55/ / / / / / / / / /  4f4$$If!vh#v#v &:V l055 &/ /  4$$If!vh#v+:V l4  05+/ /  4f4p DeCheck1RCheck only if no work was performed and no animals were used during the past year.~DeCheck2Check only if work was performed and animals were used during the past year. The progress report form must be completed and attached.DText241Co-PI's or Sponsor's primary academic department.DText241Co-PI's or Sponsor's primary academic department.DText241Co-PI's or Sponsor's primary academic department.DText241Co-PI's or Sponsor's primary academic department.vDeCheck12vDeCheck13~DeCheck3Check only if the protocol is to be terminated. All work with animals must cease by the end of the current one-year approval period.DCheck4Checking this box certifies that there is no change in personnel or animal species, number, housing, or procedures from the protocol, including amendments, as already approved. sCheck only if work will continue as described in the existing approved protocol and amendments. F1 for more help. DeCheck5Check only if there are changes in personnel or animal activities from those approved in the existing protocol, including amendments. DCheck6If you are uncertain about the classification of the change, or if major changes also will be made, check the Major and/or Minor change box instead.yCheck only if all changes are minor, as defined on the face page of the Minor Change in Activity form. F1 for more help.DCheck7This box should be checked if both major and minor changes are planned, or if there is doubt about the classification of the change.Check if any change is not among those defined as minor on the face page of the Minor Change in Activity form. F1 for more help. DCheck7This box should be checked if both major and minor changes are planned, or if there is doubt about the classification of the change.Check if any change is not among those defined as minor on the face page of the Minor Change in Activity form. 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