University of Baghdad

College of Science

Research ethics committee

csec@sc.uobaghdad.edu.iq

Application for the use of animal experiments

PART 1: Identification
1.1	Project Title
1.2	Principal Investigator Full Name: Position: Email: University/Institutional Affiliation/ Department:
If this is a student/graduate/resident project, please provide the following information:
a) Student Name:	b) Supervisor Name:
1.3	Research Site(s) where project will be carried out:
1.4	Proposed Project Period: From Click or tap to enter a date. To Click or tap to enter a date.
1.5	Name of funding source:

PART 2: ANIMAL
2.1	Species: Age/weight: Sex: Total number: Number per group:
2.2	Describe in detail all the procedures on animals:

PART 3: SEVERITY AND ANIMAL WELLBEING
3.1	Severity: ☐ None ☐ Mild ☐ Moderate ☐ Severe
3.2	Ending the experiment and disposal of animals: ☐ Keeping alive ☐ Euthanasia ☐ Others, specify

PART 4: THREE R’S: REPLACEMENT
4.1	Are there alternative methods that can be used in this study rather than live animals and if so, pleas state?
4.2	Why is animal usage necessary for these studies?
4.3	Why are the particular species selected required?
4.4	Have similar experiments been conducted in the past. If yes, why the new experiment is required?

PART 5: THREE R’S: REDUCTION
5.0	Justification of the number of the animals:

PART 6: THREE R’S: REFINEMENT
6.0	Specify which methods are used to reduce the inconvenience (pain, suffering, anxiety): ☐ Analgesics ☐ Anesthesia ☐ Anti-inflammatory drugs ☐ Others, specify

PART 7: CONFLICT OF INTEREST
7.0	Is there any real or perceived conflict of interest (any personal or financial interest in the conduct or outcome of this project)? Will any of the researcher(s), members of the research team and/or their immediate family members: ☐ YES ☐ NO If yes, please describe the personal benefits or relationship.

PART 8: Declaration by Principal Investigator (or Supervisor for student projects)
Project Title:
I confirm that the information provided in this application is complete and correct. I accept responsibility for the ethical conduct of this project and for the protection of the rights and welfare of the human participants who are directly or indirectly involved in this project. I will ensure that any significant changes to the project, including the proposed method, consent process or recruitment procedures, will be reported to the College of Science Research Ethics Committee for consideration in advance of its implementation. Signature of Principal Investigator Printed Name of Principal Investigator Date Signature of Student Investigator Printed Name of Student Investigator Date