Research Office
Research Hub, Building C5C East
MACQUARIE UNIVERSITY NSW 2109
Animal Ethics Secretariat
Phone +61 (0)2 9850 7758 / 4456
Email [email protected]
Macquarie University
Animal Ethics Committee
Reporting Form for Unexpected Adverse Events
(Version 2.2 – May 2012)
OFFICE USE ONLY
Reference no.:
Date received:
AEC meeting date:

It is the policy of the Animal Ethics Committee (AEC) that unexpected adverse events, including
unexpected deaths, are reported to the Animal Welfare Officer (AWO) within 72 hours. Email
[email protected] (Att: AWO) or call (02) 9850 7758 or 0439 497 383

An unexpected adverse event is an outcome that is not described in the AEC approved protocol and one that
has a negative effect on animal welfare, i.e. is not good from the animal’s point of view (e.g. the experience
of pain and/or distress).

An unexpected death is a death that occurs prior to the approved experimental endpoint. This includes
death as a result of unplanned euthanasia and death under anaesthesia.

The information in this form is required under sections of the Code of Practice for the Care and Use of
Animals for Scientific Purposes (NHMRC 2004 7th Ed.) that relate to keeping records and reporting unexpected
and/or adverse events/impacts/effects (Sections 2.2.27, 2.2.28, 3.1.9 and 3.1.12).

Information provided in this report will be presented by the AWO at the next scheduled AEC meeting after
the date of receipt. The report will be filed with all other records pertaining to your animal research protocol.
Instructions for Submission of this form

Attach any supporting documents (e.g. veterinary or pathology reports)

The form must be typed (not hand written) and signed by the Principal Investigator or their delegate

Please email completed forms to BOTH [email protected] (Att: AWO) AND to the manager of the
facility in which the animal is being held.
1. Protocol details
Protocol Number (Animal Research Authority)
Project title
Name of Principal Investigator
2.
Details of animal
Species (and strain if appropriate)
Identification number of animal
Location of animal at time of adverse event
Date of adverse event
3.
Describe the event: what happened? Include details of the symptoms and/or signs exhibited by
the animal, e.g. weight loss, diarrhoea, other signs of injury or distress, or found dead.
4.
At what stage of the experiment did the event occur? What treatments/procedures had been
performed on the particular animal(s) prior to the event? It may assist to include a timeline of
events.
5.
How many animals were in the treatment group the animal belonged to? (e.g. 1 animal died out of
a group of 20, 1 tank of fingerlings out of 5 tanks).
6.
What action was taken when the event happened or was discovered? (e.g. animal euthanased, vet
called, pain relief was administered and animal monitoring increased to ...).
7.
Why/how do you think it happened? What investigations have taken place? (e.g. necropsy,
histopathology, haematology, faecal tests, microbial culture were/were not performed because ...)
8.
What immediate and long-term actions are being taken to prevent a recurrence? (e.g. modification
to procedures or experimental design, housing, monitoring or researcher/student training or
supervision)
9.
Is this a one-off event or has it happened before? (if it has happened before, document when and
please explain how the recurrence couldn’t be prevented)
10. Is there any other information or comment you wish to provide in relation to this event?
11. Declaration:
I declare that this is a true and correct statement of the event
Signature of Principal Investigator
or delegate
Printed Name
Date
D:\81910310.doc