IRB Forms

IRB Submission requirements are as follows:

The following documents are required for IRB review. Please complete all the necessary forms. You may follow up with the IRB for further information.

Initial IRB Forms

WORD

PDF

     

Initial Application

docx ✓

pdf ✓

Consent Form Template

docx✓

N/A

Assent Form

docx ✓

N/A

Parental-Guardian Consent Form

docx ✓

N/A

Research Proposal Outline (guide)

docx ✓

pdf ✓

HIPAA Waiver of Authorization
–submit accordingly

docx ✓

N/A

Notice of Privacy Practices (NOPP)

docx ✓

pdf ✓

Notice of Privacy Practices (NOPP)
- Child Version

docx✓

N/A

CITI Program Instructions

N/A

pdf ✓

MRI Consent Form Standard Language

docx ✓

 

   

Covid-19 Related Information

     

Covid-19 Script

docx✓

N/A

Covid-19 Participant Information

docx✓

N/A

   

Submission Requirements

     

Submission copies – Full Board,
Expedited, Exempt

N/A

pdf ✓

Submission Checklist

N/A

pdf ✓

Submission Deadline

docx✓

pdf ✓

Attachment A – IRB Protocol submissions

N/A

pdf ✓

Attachment B – Citations

N/A

pdf ✓

Attachment C- PI Responsibility

N/A

pdf ✓

   

Continuation Review requirements are as follows: All active human studies at Kessler Foundation must be reviewed by the IRB at intervals appropriate to the degree of risk but not less than annually, for continuation of approval. Review the IRB Deadlines and Meeting dates for submission.

Continuation Forms

     

Continuation Application

docx ✓

pdf ✓

Amendment Forms

     

Amendment Application

docx ✓

pdf ✓

   

Adverse Event Forms

       

Adverse Event Log(form 5010a)

 

docx ✓

pdf ✓

Serious Adverse Event Report (form 5010b)

 

docx ✓

pdf ✓

Unexpected Adverse Event Report (form 5010c)

 

docx ✓

pdf ✓

Irregularities / Non-Compliance Form

 

N/A

pdf ✓

Participant Suicide Ideation Form

 

N/A

pdf ✓

 

Other Forms

     

IRB Authorization Agreement(form 5010a)

docx ✓

N/A

Authorization of Medical Release Form

docx ✓

pdf ✓

Media Consent Form

N/A

pdf ✓