動(dòng)物實(shí)驗(yàn)倫理審查表

1、動(dòng)物實(shí)驗(yàn)倫理審查表TheTabofAnimalExperimentalEthicalInspection編號(hào)(N?)：申請(qǐng)單位(Nameofganization)：申請(qǐng)人學(xué)歷(Educationofapplicant)：技術(shù)職稱(Professionaltitle)：崗位證書(shū)編號(hào)(Numberofpermit)：實(shí)驗(yàn)名稱(Studytitle)：實(shí)驗(yàn)?zāi)康?Aimofexperiment)：動(dòng)物來(lái)源(Sourceofanimal)：品種品

2、系(Speciesstrain)：等級(jí)(Grade)：數(shù)量(Number)：只(♀只；♂只)申請(qǐng)日期(Applicationdate)：年月日擬進(jìn)動(dòng)物情況進(jìn)駐日期(Enteringdate)：年月日結(jié)束日期(Endingdate)：年月日實(shí)驗(yàn)要點(diǎn)包括實(shí)驗(yàn)方法、觀測(cè)指標(biāo)、實(shí)驗(yàn)結(jié)束后處死動(dòng)物的方法等(Outlineofexperimentsexperimentalmethodsobservationalindexexecutinganima

3、lmethodet.al)：申請(qǐng)人填寫(xiě)的相關(guān)信息(Concernedinfmationwrotebyapplicant)申請(qǐng)人簽名(Signatureofapplicant)：聯(lián)系電話(Telephone)：審查依據(jù)(Inspectioncontents)該項(xiàng)目是否必須用實(shí)驗(yàn)動(dòng)物進(jìn)行實(shí)驗(yàn)，即能否用計(jì)算機(jī)模擬、細(xì)胞培養(yǎng)等非生命方法替代動(dòng)物或用低等動(dòng)物替代高等動(dòng)物進(jìn)行實(shí)驗(yàn)(Doeslabatyanimalmustbeusedinthepro

4、jectCouldothermethodssuchascomputersimulationcellcultivationusingthelowgradeanimalinsteadofthehighgradeanimal)？表中所填申請(qǐng)人資格和所用動(dòng)物的品種品系、質(zhì)量等級(jí)、規(guī)格是否合適，能否通過(guò)改良設(shè)計(jì)方案或用高質(zhì)量的動(dòng)物來(lái)減少所用動(dòng)物的數(shù)量(Arethequalificationofapplicant，speciesstraingrad

5、especificationsofanimalssuitableCouldthequantityofanimalsbereducedbyimprovingthestudydesignusinghighqualityanimals)？能否通過(guò)改進(jìn)實(shí)驗(yàn)方法、調(diào)整實(shí)驗(yàn)觀測(cè)指標(biāo)、改良處死動(dòng)物的方法，來(lái)優(yōu)化實(shí)驗(yàn)方案、善待動(dòng)物(Couldthestudydesignanimaltreatmentberefinedbyameliatingexperi

6、mentalmethodadjustingobservationalindexexecutinganimalmethod)？課題負(fù)責(zé)人意見(jiàn)(Studydirect)：同意(Agree)□不同意(Disagree)□簽名(Signature)實(shí)驗(yàn)動(dòng)物部主任意見(jiàn)(DirectofDept.ofLabAnimalScience)：同意(Agree)□不同意(Disagree)□簽名(Signature)審查結(jié)果(是否同意申請(qǐng)人的實(shí)驗(yàn)方案)(R

7、esultsofinspection)醫(yī)學(xué)部實(shí)驗(yàn)動(dòng)物福利與倫理委員會(huì)&WelfareCommittee)：同意(Agree)□不同意(Disagree)□備注(Supplement)：簽章(Stamp)動(dòng)物實(shí)驗(yàn)倫理審查表TheTabofAnimalExperimentalEthicalInspection編號(hào)(N?)：申請(qǐng)單位(Nameofganization)：申請(qǐng)人學(xué)歷(Educationofapplicant)：技術(shù)職稱(Prof

8、essionaltitle)：崗位證書(shū)編號(hào)(Numberofpermit)：實(shí)驗(yàn)名稱(Studytitle)：實(shí)驗(yàn)?zāi)康?Aimofexperiment)：動(dòng)物來(lái)源(Sourceofanimal)：品種品系(Speciesstrain)：等級(jí)(Grade)：數(shù)量(Number)：只(♀只；♂只)申請(qǐng)日期(Applicationdate)：年月日擬進(jìn)動(dòng)物情況進(jìn)駐日期(Enteringdate)：年月日結(jié)束日期(Endingdate)：年月日

9、實(shí)驗(yàn)要點(diǎn)包括實(shí)驗(yàn)方法、觀測(cè)指標(biāo)、實(shí)驗(yàn)結(jié)束后處死動(dòng)物的方法等(Outlineofexperimentsexperimentalmethodsobservationalindexexecutinganimalmethodet.al)：申請(qǐng)人填寫(xiě)的相關(guān)信息(Concernedinfmationwrotebyapplicant)申請(qǐng)人簽名(Signatureofapplicant)：聯(lián)系電話(Telephone)：審查依據(jù)(Inspection

10、contents)該項(xiàng)目是否必須用實(shí)驗(yàn)動(dòng)物進(jìn)行實(shí)驗(yàn)，即能否用計(jì)算機(jī)模擬、細(xì)胞培養(yǎng)等非生命方法替代動(dòng)物或用低等動(dòng)物替代高等動(dòng)物進(jìn)行實(shí)驗(yàn)(DoeslabatyanimalmustbeusedintheprojectCouldothermethodssuchascomputersimulationcellcultivationusingthelowgradeanimalinsteadofthehighgradeanimal)？表中所填申請(qǐng)人資

11、格和所用動(dòng)物的品種品系、質(zhì)量等級(jí)、規(guī)格是否合適，能否通過(guò)改良設(shè)計(jì)方案或用高質(zhì)量的動(dòng)物來(lái)減少所用動(dòng)物的數(shù)量(Arethequalificationofapplicant，speciesstraingradespecificationsofanimalssuitableCouldthequantityofanimalsbereducedbyimprovingthestudydesignusinghighqualityanimals)？能否通

12、過(guò)改進(jìn)實(shí)驗(yàn)方法、調(diào)整實(shí)驗(yàn)觀測(cè)指標(biāo)、改良處死動(dòng)物的方法，來(lái)優(yōu)化實(shí)驗(yàn)方案、善待動(dòng)物(Couldthestudydesignanimaltreatmentberefinedbyameliatingexperimentalmethodadjustingobservationalindexexecutinganimalmethod)？課題負(fù)責(zé)人意見(jiàn)(Studydirect)：同意(Agree)□不同意(Disagree)□簽名(Signature