I.

Project Title:

Short Title:

Initiation Date:

Study Director:

Principal Technicians:

Approved: ___________________________________________________________

XX, Principal Investigator

Date: _________________________

II. Background
 The aim of this study
 Introduction to subject
 Literature values that the design is build on. Maybe even a table:

Table 1. Overview of Prochloraz toxicity (EC50 ± SE) for 48hr acute tests and 21-day reproduction tests

Type of test Organism/clone EC50 ± SE (mg/L) Reference

48 hr acute test Daphnia magna /DK-clone 3.5 ± 0.4 (Nørgaard and

Cedergreen, 2010)

48 hr acute test Daphnia magna /F-clone 4.9 ± 1.3 Own data

III. Purpose:

IV. Hypotheses:

V. Experimental Design:
 Is it based on an OECD guideline?
 Concentrations used
 Do you need a solvent and solvent control)
 No. of animals/amount of homogenate/amount of microsomes

1
VI. Conditions:
Animal Source:

Room:

Shelf:

Temperature:

Water Volume:

Test vessel:

Animals Density:

Food:

Treatment Renewal Frequency:

Light/Dark hours:

VII. Data Collection:

 What data is collected?
 How is data collected?
 How often?

VIII. Dispositions:

IX. Abbreviations

X. Supplies
 Glasses/vials/microplates
 no. of animals
 labelling tape
 amount of chemical

XI. Calendar of Events:

XII. Appendices:

References

2
3