Investigator Self-Report of Reporting and Investigating Animal Welfare Concerns, Noncompliance, Unexpected Findings, or Adverse Events — Institutional Animal Care and Use Committee

Please use this form to self-report unexpected findings, adverse events, or noncompliance as per IACUC policy “Reporting and Investigating Animal Welfare Concerns, Noncompliance, Unexpected Findings, or Adverse Events.” If you have any questions, please contact the IACUC office (iacuc@louisville.edu) or CMRU Veterinary Faculty. Please note that the IACUC looks favorably upon self-reporting of items listed in this policy. Reporting these events fosters protection of the integrity and credibility of the institution and demonstrates a culture of care. THIS REPORTING LINK IS NOT ANONYMOUS. Animal Welfare Concerns may be submitted anonymously via the University’s third-party Compliance Hotline (877-852-1167) or by using the link to the third-party vendor on their website (http://louisville.edu/compliance/hotline). A trained risk specialist will document your information and generate a written report to the University Integrity and Compliance Office for follow-up.

Your Name

Your E-Mail Address

IACUC Proposal Number

PI Name

Is this an Animal Welfare Concern, Noncompliance, Unexpected Finding, or Adverse Event??

Date of the Incident

Location where the Incident Occurred

Species and Number of Animals Involved

Description of What Happened Please provide as much detail as possible to include the # of animals affected and any adverse consequences to animal welfare. The reports should also ensure “veterinary consultation when pain or distress is beyond the level anticipated in the protocol description or when interventional control is not possible” (Guide 2011).

Corrective Action Plans Describe the immediate steps taken to address the situation, including any veterinary intervention, and plan for preventing future occurrences, including a timeline for implementation.

Please provide the funding sources for this proposal. Also, include the NIH Grant Number, the DOD ACURO protocol number, or the VA ACORP number as applicable.