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Animal Protocol
Post Approval Survey Check List
Principal Investigator or direct representative
must be present at survey. All 'No' answers require comment by
surveyor.
| Principal Investigator: |
|
| Protocol #: |
|
| Effective Dates:
|
|
| Survey Date: |
|
| Surveyed by: |
|
| Title: |
|
| Researchers Present: |
|
| Animal
Information |
Present
Year |
Previous
Year |
| Number
of animals approved |
|
|
| Number
of animals ordered |
|
|
| Number
of animals used |
|
|
| Pain
category |
|
|
| Date
checked |
|
|
|
The Protocol and Personnel
| Y |
N |
n/a |
|
1. Do the PI and
surveyor have the most recent version of the protocol? |
| Y |
N |
n/a |
|
2. Are all appropriate
personnel listed in the protocol? |
| Y |
N |
n/a |
|
3. Have all personnel
been trained (mandatory, species-specific, surgery)? |
| Y |
N |
n/a |
|
4. Are personnel
interviewed familiar with their responsibilities as outlined
in the "Guide"? |
| Y |
N |
n/a |
|
5. Is there an
approved protocol? |
| Y |
N |
n/a |
|
6. Do the PI and
staff have accurate knowledge of the protocol? |
| Y |
N |
n/a |
|
7. Is personal
protective equipment appropriate to the species and procedures
underway in use? |
| Y |
N |
n/a |
|
8. Are all personnel
enrolled in the AESP? |
Study Procedures
| Y |
N |
n/a |
|
8. If the protocol
has a condition, has it been met? |
| Y |
N |
n/a |
|
9. Are the procedures
in use consistent with approved protocol? |
| Y |
N |
n/a |
|
10. Are species,
strain, ages, sex and number of animals being used consistent
with approved protocol? |
Anesthesia
| Y |
N |
n/a
|
|
11.
Are the methods of anesthesia in compliance with what is written
in the protocol? |
| Y |
N |
n/a
|
|
12.
Are anesthetized animals monitored according to the approved
method in protocol? |
| Y |
N |
n/a
|
|
13.
If inhalant anesthetics are used, are they scavenged properly? |
| Y |
N |
n/a
|
|
14.
Are anesthetic machines serviced and calibrated? |
Post-Surgical Care
| Y |
N |
n/a
|
|
15.
Is post-surgical care in compliance with what is written in
the protocol? |
| Y |
N |
n/a
|
|
16.
Are the methods of analgesia (dose, frequency, duration) consistent
with the approved protocol? |
| Y |
N |
n/a
|
|
17.
Are antibiotics being used as approved? |
| Y |
N |
n/a
|
|
18.
Is post surgical (post procedural) care adequately documented? |
Euthanasia
| Y |
N |
n/a
|
|
19.
Does the method of euthanasia correspond with what is written
in the protocol? |
| Y |
N |
n/a
|
|
20.
Is the final disposition of the animal recorded? |
General Record Keeping
| Y |
N |
n/a
|
|
21.
Is there an up to date and complete surgical log? |
| Y |
N |
n/a
|
|
22.
Are animals identified by protocol number and individual numbers
or cage cards? |
| Y |
N |
n/a
|
|
23.
Are medical progress notes complete and accurate? |
| Y |
N |
n/a
|
|
24.
Are medications such as antibiotics, accurately documented?
|
| Y |
N |
n/a
|
|
25.
Is there an up to date inventory of the number of animals
used in each pain category? |
| Y |
N |
n/a
|
|
26.
Are injections, blood collection, and fluid collection amounts
dated documented? |
Surgical Facilities
| Y |
N |
n/a
|
|
27.
Are surgical procedures being performed in an area approved
by the ACUC? |
| Y |
N |
n/a
|
|
28.
Is rodent surgery is performed in the laboratory? |
| Y |
N |
n/a
|
|
a.
Is the operative field shaved (if not, is there documentation
that it is not necessary)? |
| Y |
N |
n/a
|
|
b.
Is an antiseptic solution, such as Betadine, applied? |
| Y |
N |
n/a
|
|
c.
Are clean instruments being used? (bacteriocidal solution
or glass bead sterilizer) |
| Y |
N |
n/a
|
|
d.
Are clean, wrapper-protected gauze and cotton swabs used? |
| Y |
N |
n/a
|
|
e.
Are implanted devices (catheters, etc) sterilized before use? |
| Y |
N |
n/a
|
|
29.
Is there an appropriate recovery area for this species? |
| Y |
N |
n/a
|
|
30.
Does the laboratory have a dedicated workspace for animal
procedures? |
| Y |
N |
n/a
|
|
31.
Does the facility/area comply with appropriate standards? |
| Y |
N |
n/a
|
|
32.
Are facilities clean and organized? |
| Y |
N |
n/a
|
|
33.
If animals are held in the laboratory, are they returned to
animal quarters by 12 hours? |
| Y |
N |
n/a
|
|
34.
If no, does the PI have written authorization from the ACUC? |
| Y |
N |
n/a
|
|
35.
Are all drugs, fluids, sutures, etc., within the expiration
dates? |
| Y |
N |
n/a
|
|
36.
Are scheduled drugs stored in a separate locked cabinet or
drawer? |
Additional
Questions Pertinent to this Protocol (use additional page if needed)
Recommendations
for improvement of animal care and use
IACUC
action requested to continue protocol approval
Sequence
of events following Investigator noncompliance with record keeping
requirements
a) Discussion with Training and Compliance Administrator
and generating a plan for correction.
b) Letter from Training and Compliance Administrator requesting
corrective action.
c) Letter from IACUC requesting corrective acting.
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