IACUC Concern Report

Institutional Animal Care and Use Committee (IACUC) Animal Welfare Concern Report Form
Please complete this form if you have a concern about the possible mishandling or mistreatment of an animal(s) involved in any Cary Institute scientific or educational endeavor.

Confidentiality & Non-Retaliation Statement: Cary Institute of Ecosystem Studies encourages the reporting of animal welfare concerns and prohibits retaliation against individuals who report in good faith. You may submit this form anonymously.
Fields marked with an asterisk (*) are required.
Date of Report*

MonthDayYear
Date
Would you like to remain anonymous?*

YesNo
Description of the Concern/Observation:*
Please provide a detailed description of the concern or incident, including what was observed, how frequently it occurred, and why it may be a violation of animal welfare standards or approved Cary Institute animal care and use protocols.
Date(s), Time(s) & Location(s) of Incident/Observation (if applicable):
Animal Species Involved:
Individuals Involved:
Submitted by (optional):
[Your name, or write “Anonymous”]
Email/Phone (optional):
[Insert contact, or leave blank]
Please verify that you are human*
Should be Empty:

Institutional Animal Care and Use Committee (IACUC) Animal Welfare Concern Report Form