Standard Operating Procedure for Semiannual Facility Inspections

Revised December 11, 2008

General

The NCSU IACUC is responsible for the inspection of all sites where vertebrate animals are housed or used for purposes of research, teaching, and testing. The frequency and specific methodology of these inspections varies with the type of activity conducted, discussed further below. In general, all housing sites, and all areas where survival surgery is conducted are inspected at least once every six months. All areas where animals are used but not housed for more than 12 hours are inspected periodically.

Overview of Inspection Frequency

• All facilities where animals are housed for 12 hours or more:  inspected every six months by at least two voting members of the IACUC. 
• All facilities/areas where survival surgery is performed: inspected every six months by at least two members of the IACUC.
• All other areas where animals are used, but not housed more than 12 hours: inspected periodically based on judgement of UAV; some but not necessarily all areas inspected every six months.

Responsibilities – IACUC Coordinator

• Maintain schedule to ensure that visits are conducted at appropriate intervals.
• Maintain list of facilities, including satellite areas, unit attending veterinarians, and other contacts (as appropriate)
• Maintain list of laboratories w/ animal use and contact
• For Inspections:
  • Begin planning inspection scheduling at least one month in advance of due date of inspection.  Note:  The University Attending Veterinarian and the IACUC Administrator should be included in all inspections, if possible.  All members should be notified of all inspection schedules at least two weeks in advance in order to allow them to participate if desired.
  • Provide to the UAV: list of inspection sites, contacts, laboratories, previous inspection report(s), and checklists
  • Arrange inspection schedule with appropriate unit personnel in consultation with the UAV
  • Arrange for transportation, in consultation with UAV
  • Notify IACUC members of inspection schedule
• Take notes during the inspection, prepare the inspection reports
• Writing the report:
  • Use the attached format for drafting the inspection report. Each unit should have a separate report, although laboratories in the same building may be covered along with the central animal housing unit. Each deficiency or comment should be numbered, and the checklists should be attached.
  • Deficiencies are separated into significant vs. minor.  A significant deficiency is one that is or may be a threat to the health or safety of the animals. Most IACUCs would also include as significant something that poses a threat to personnel health or safety.
  • For each deficiency, include a description of the deficiency (what was seen and where), and explanation of why it's a deficiency (e.g., failure to satisfy specific regulation or guideline). The report may refer to group of common problems, as long as detailed on the attached checklist. For example, "There was chipped and peeled paint on walls and floors of several animal rooms (see attached)."
  • Comments/Suggestions may be used to document observations that are not, or perhaps should not, be considered a "deficiency."  Include commentary that explains why the observed situation could be improved upon, and how it might be so improved. This section should include update on previously noted deficiencies, and it also may be appropriate to include here a commendation (statement that identifies program, physical plant and/or personnel strengths).
  • Distribute prepared reports to full committee for review by email with this instruction:

    "The attached inspection report has been prepared for your review.  Please respond by (insert date here – 5 working days) regarding your review of the attached document.  If you wish to request discussion of this report at the next convened quorum, please indicate this in your response.  Otherwise, if further discussion is not requested by (insert date here) this report will be forwarded to the appropriate personnel.  If minor deficiencies are noted in the report, the recipient will be instructed to provide a response using the appropriate form within 30 days of receipt of the report.  If a significant deficiency has been noted in the report, the recipient will be required to provide us with a response within 10 working days."

• Distribute approved reports to unit managers and other contacts, copying appropriate administrators, and ensure that responses are received as appropriate;  For reports noting deficiencies, prepare and send an “Inspection Report Response Form” along with the inspection report.
• Responses received from units are to be reviewed by the committee in the same manner as reports (see above).
• Assemble final approved reports and responses.  Forward to the IACUC Administrator to be included in the Semiannual Program Review Report to the Institutional Official

Responsibilities – University Attending Veterinarian

• Participate in all inspection site visits, if possible
• Provide guidance and feedback with drafting of reports, as requested by IACUC Compliance Coordinator
• Provide recommendations for inspection of facilities where animals are used, but not housed for more than 12 hours.

Responsibilities – IACUC Administrator

• Participate in all inspection site visits, if possible
• Provide guidance and feedback with drafting of reports, as requested by IACUC Compliance Coordinator
• If reports are flagged for discussion at a convened quorum, place on the agenda for the next scheduled meeting.
• Assemble reports and program review evaluations for submission to the Institutional Official.

• Inspection Report Template
• Facility Inspection Report Response Form