違反實驗動物福祉檢舉通報表 Violation of Animal Welfare Reporting Form

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依動保法第十六條，雙和實驗動物照護及使用委員會為動物科學應用監督單位，為避免使用者在相關之科學應用發生違反動物福祉之情事，特設立本通報表單。若發現以下違反動保法情事，可進行舉發:
1. 未取得IACUC核可逕行執行動物實驗。
2. 實驗動物長期飼養於環境不良之區域。
3. 實驗動物長期受不良操作。
4. 實驗動物長期遭受痛苦而未進行處理。
5. 其他違反動物福祉疑慮者。
Based on the Animal Protection Act and on the behalf of the IACUC, the LAC, the following situations can be reported:
1. Conduction of animal experiments without IACUC approval.
2. Experimental animal are housed in unhealthy environment for long term.
3. Experimental animal are suffering maltreatment.
4. Experimental animals are suffering pain for long term without taking any action.
5. Other actions may violate the animal welfare.

您的姓名(可不回答) Your Name (optional):

您的聯絡方式 (可不回答) (電話與Email) Your contact information (phone and email) (optional):

違反實驗動物福祉之單位 The department/institute where the animal welfare violation happened:
*

違反實驗動物福祉之計畫主持人 The project PI's name whose experimental animals were suffering violation:
*

您認為違反下列哪些事項 Which of the following situation do you think happened to the violation case:

未取得IACUC核可逕行執行動物實驗 Conduction of animal experiments without IACUC approval.

實驗動物長期飼養於環境不良之區域 Experimental animal are housed in unhealthy environment for long term.

實驗動物長期受不良操作 Experimental animal are suffering maltreatment.

實驗動物長期遭受痛苦而未進行處理 Experimental animals are suffering pain for long term without taking any action.

其他違反動物福祉疑慮者 Other actions may violate the animal welfare.

違反實驗動物福祉之操作日期 The operation date of animal welfare violation:
*

YYYY

違反實驗動物福祉之操作時間 The happening time of animal welfare violation:
*

Time

請詳細描述違反實驗動物福祉之操作地點、參與人員等相關事證(若有照片請附上)。Please describe the details about where, whom and the relevant evidences of animal welfare violation (provide pictures if possible). *

其他補充事項 Others to be noted:

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