Forms

Application Forms

IACUC Application

Save this form to your computer as a Word file. Type all responses. Fields are expandable. Please submit to IRB@georgiasouthern.edu in a single email.

Emergency Husbandry Form

For Animals Housed on Campus

Emergency husbandry plans are required to be updated within the last 30 days prior to new and renewal applications. Each researcher only needs one plan and should include all their animals on this one document.

• For New Researchers: Email us at irb@georgiasouthern.edu to request access to the Emergency Husbandry Plan Google Drive Folder.  Then you can submit an Emergency Husbandry Form by uploading as a Google Doc to the folder.
• For Existing Researchers:   To “submit” your emergency husbandry plan, please edit your existing plan in the Emergency Husbandry Plan Google drive. 

Note: If you are a student, this must be submitted by your faculty adviser.

Essential Personnel List

For Animals Housed on Campus

The IACUC Essential Personnel List must be verified within the last 30 days prior to each new IACUC application and each renewal submission. Make sure you update the “Last Updated” column even if no changes need to be made.

• New Researchers: Email irb@georgiasouthern.edu to request access to the Essential Personnel List.

This must be completed by a faculty member.

Appendices (Complete if applicable)

• Appendix A – Special Husbandry
• Appendix B – Hazardous Substances
• Appendix C – Specimen Collection
• Appendix D – Surgery
• Appendix E – Other Experimental Procedures
• Appendix F – Field Study – Wild Catch
• Appendix G – USDA Pain Category Chart (informational only)

Biology Research Facility Request Form

Form used to request the use of animal research facility space from the Department of Biology.

Medical Clearance Questionnaire (Animal Handler Form)

(Physicians Use Only – Vaccination)

• GS Personnel – For medical clearance to work with animals – medical practitioner evaluation required.  Submit completed form to Health Center. Click here for further directions.
• Non-GS Personnel –  investigators or research personnel listed on a protocol – See Medical Clearance page “Who should participate“

Medical (Occupational) Health Risk Brochure

Required for all animal users, students, and individuals with ancillary access to research or education animals.

Postmortem Tissue Collection

Documentation for postmortem tissue collection for tissues acquired but not covered as part of an IACUC protocol on which you are listed.

IACUC Extension or Project Termination

Use this form to extend or terminate an approved IACUC protocol. Extension requests must be received by the first day of the month in which the protocol expires.

IACUC Amendment

Use this form to amend an approved IACUC protocol.

IACUC Exemption

Use this form to request an exemption approval for field observation studies.

CITI Training Requirements

GS Researchers

• Required: “Animal Researcher’s Course – Working with the IACUC” through the CITI Program. Log in through Georgia Southern to use your institutional account.
• Training in the specific technique associated with your protocol must be supplied by faculty experience or mentor training and documented in your application.

Non-GS Researchers

• May use Georgia Southern’s online basic training and/or provide proof of equivalent training from their home institution. (See Non-GS login directions for collaborators.)
• Must also provide a CV or other recognized certification documenting skill in animal handling techniques associated with the protocol.

Additional IACUC Forms

1. Weekly Animal Checklist – For use by researchers in tracking animal welfare checks. Must be current and readily available at all times.
2. Facility Inspection – Biology – For use by facility managers, staff, and IACUC members in evaluating facility compliance.
3. Facility Inspection – Wildlife Center – For use by facility managers, staff, and IACUC members in evaluating facility compliance.
4. Adoption Form – Contact the Research Compliance Officer prior to use.
5. Adverse Event Form – For use when unanticipated events occur. Veterinarian contact required.
6. Performance Site Agreement Form – To be used when animal acquisition, care, housing, and research are completed at a federally assured facility not covered by the Georgia Southern assurance.
7. Holding Protocol Enrollment Agreement – Requires signature of the IACUC Chair.
8. Rabies Vaccine Information Sheet – CDC Rabies – What You Need to Know.
9. Georgia Southern University Researcher Participation Standard Release – A waiver of liability for students participating in research projects as student researchers. Waivers should be maintained by the faculty member. If the faculty member leaves Georgia Southern, all current waivers (less than 3 years old or for ongoing field work) must be turned over to the departmental office for retention.
10. Animal Cage Identification Plate – Required for all housed animals.
11. IACUC SOP Template – Standard format for submission of proposed Standard Operating Procedures for Animal Care and Use at Georgia Southern.
12. Emergency Husbandry Form – Keep up-to-date instructions for the basic care of your animals housed in University space in case you are unable to make it to campus (e.g., hurricane, illness, quarantine).

Resources

1. Guide for the Care and Use of Laboratory Animals – The eighth edition has been reviewed in draft form by individuals chosen for their diverse perspectives and expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council.
2. Guide for the Care and Use of Agricultural Animals in Teaching and Research (Ag Guide – 4th ed.) – Published by the Federation of Animal Science Societies (FASS). This serves as a primary reference document for meeting the needs and requirements of agricultural animals utilized in research and teaching.
3. Animal Welfare Act – Full Animal Welfare Act in PDF format.
4. Good Laboratory Practice Regulations (FDA and EPA) – Comparison chart of FDA and EPA Good Laboratory Practice (GLP) regulations and the OECD Principles of GLP.
5. USDA’s Animal Welfare Information Center – Information regarding relevant laws, regulations, and discussions of animal care and use.
6. NIH Grant Application Vertebrate Animal Section (VAS) Guidance – Clarifies information that must be included in the Vertebrate Animal Section (VAS) of grant applications and cooperative agreements that use live vertebrate animals in research. Explains how VAS is evaluated as part of the NIH peer review process and distinguishes between the oversight role of the Institutional Animal Care and Use Committee (IACUC) and the review responsibility of the NIH Scientific Review Group (SRG).
7. NIH VAS Training Video – Video presentation of NIH VAS sections and required test with examples and an applicant/reviewer checklist. (Approx. 20 minutes)
8. NIH VAS Fact Sheet – Outlines five points of information to be included in the VAS for each performance site.
9. Rabies Vaccine Information Sheet – CDC Rabies: What you need to know.
10. 2020 Report of the AVMA Panel on Euthanasia – Forms and information that may be used in completing IACUC protocols for review.