Satellite Facilities Application and Renewal Form

Satellite Facilities Application and Renewal Form
Appendix I
Florida Atlantic University Institutional Animal Care and Use Committee
SATELLITE FACILITIES APPLICATION AND RENEWAL FORM
First Step: INSTITUTIONAL APPROVAL AND JUSTIFICATION
Principal Investigator (PI):
PI Department:
Email Address:
Phone:
1. Type of Request
This is an Initial Request for IACUC Approval of an Investigator-Managed Satellite Animal Housing
Facility
This is an Initial Request for IACUC Approval of a Veterinary Services (VS)-Managed Satellite
Animal Housing Facility
This is a Triennial Renewal Request for IACUC Approval of a Satellite Animal Housing Facility
(Investigator or VS-Managed)
2. Specifics of Request Check / complete all boxes that apply.
Building Location:
Room(s) Location:
Animal species to be housed (in each room ):
Maximum duration a single animal will be held in this area(s):
Maximum number of animals in this location at any given time:
Maximum number of cages of animals in this location at any given time:
Housing Frequency:
Continual (reasonable expectation one or more animals will always be in this area)
Frequent (animals present 1 to 2 weeks out of any given month)
Rarely (animals present less than 1 week out of any given month)
Required For Investigator-Managed Satellite Animal Housing Facility: List all person(s) who will provide
care of animals in this Investigator-Managed location:
(Note: Individuals must also be listed on an approved animal care and use protocol and have completed training for the
appropriate specie(s). In addition, individuals must be enrolled in the Occupational Health Program for Animal Handlers.
IACUC POLICY for SATELLITE ANIMAL HOUSING FACILITIES
Initial IACUC approval: August 22, 2014
Last IACUC Review: N/A
Page 1 of 4
3.
Justification for Satellite Animal Housing Facility
a. Please provide a compelling SCIENTIFIC JUSTIFICATION for establishing this
Satellite Animal Housing Facility in support of funded research using animal
models. Please include any justification in regards for this specialized Satellite
Facility outside of centrally managed vivaria in the FAU animal care and use
program.
I am requesting IACUC approval for this animal housing facility based on the following scientific reason(s)
[Limit of 500 words or less]:
4.
5.
Any other information that is important for the institutional and IACUC’s consideration
and review of this request (optional)?
Proposed Funding Source for this specialized Satellite Facility
The following funding source(s) will be used to pay for all expenses associated with the Satellite facility
including equipment, supplies, maintenance, management and any human resources.
6. Signatures
Principal Investigator
Date:
Department Chair
Date:
Dean or Designee
Date:
Vice President of Research
Date:
Attending Veterinarian
Date:
IACUC POLICY For Satellite Animal Housing Facility
Initial IACUC approval: August 22, 2014
Last IACUC review: N/A
Page 2 of 4
Second Step: PRELIMINARY IACUC APPROVAL
APPROVAL OF PHYSICAL FACILITIES AND PROCEDURES (REQUIRED FOR INITIAL AND
RENEWAL REQUESTS FOR INVESTIGATOR-MANAGED SATELLITE ANIMAL HOUSING
FACILITIES)
If the IACUC approves the scientific justification and/or need for a specialized Satellite
Facility beyond existing centralized facilities, then the following clearances will be
required, before the IACUC can provide final approval to house animals in the facility. You
may wish to accomplish many of these tasks prior to initial submission of the animal
housing request, or you may wait until the IACUC approves the scientific justification.
Upon completion of the clearance items listed below, the investigator may email the
specific clearance item documentation (e.g. air flow measurements from HVAC
assessments; statement of clearance for Safety Audit, etc.) to the IACUC.
Clearance
HVAC assessment of the air flow
Safety Audit (if applicable)
IACUC Subcommittee Site Visit (Required
for Initial Requests only)
Date Completed
Notes
The HVAC assessment must be submitted with
the PHYSICAL PLANT AND ANIMAL CARE
PROCEDURES DESCRIPTION FORM. Contact
RI or the AV if you have questions about this.
Contact EH&S to have a Safety Audit performed if
requested by the IACUC
Contact RI to arrange for an IACUC
Subcommittee Site Visit
NOTE: Guidelines for animal care and housing are published in the NIH/NRC Guide for the Care and Use of
Laboratory Animals. You may download a copy of this document from The National Academies Press, or
call the Division of Research Integrity for a copy of this book.
IACUC POLICY For Satellite Animal Housing Facility
Initial IACUC approval: August 22, 2014
Last IACUC review: N/A
Page 3 of 4
*** DO NOT WRITE BELOW THIS LINE ***
*** IACUC ACTIONS ***
Scientific Justification Review:
Approved
Deferred – Clarifications Required
Disapproved
Date of IACUC consideration:
IACUC Consideration of Satellite Animal Holding / Housing Location:
Approved
Deferred – Clarifications Required
Disapproved
Date of IACUC consideration:
IACUC POLICY For Satellite Animal Housing Facility
Initial IACUC approval: August 22, 2014
Last IACUC review: N/A
Page 4 of 4
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