Institutional Review Board
IRB Forms
| General Forms |
| OSIRIS II Checklist (PDF) |
| IRB Cover Sheet (Word) (PDF) |
| Industry Sponsored Fee Information Sheet (Word) (PDF) |
| Fee Waiver Request Form (Word) |
| Research Study Renewal Report Form (Word) (PDF) |
| Modification Request Form (Word) (PDF) |
| IRB Receipt Form (Word) (PDF) |
| Reviewer Report Form (Word) (PDF) |
| Translator Certification (Word) |
| Honest Broker Assurance (Word) (PDF) |
| Exempt Study Review |
| All Applications for IRB Exempt Status Including Anonymous Use of Residual Biological Samples or Banked Tissues Samples are located on the Exempt Pages. |
| Reportable Events |
| IRB Internal Reportable Event Form for the Investigator (Word) (PDF) |
| IRB External Reportable Event Report Form for the Investigator (Word) (PDF) |
| IRB Reportable Event Form for the Reviewer (Word) (PDF) |
| Reportable Events Involving Risks to Subjects or Others during Research Study (Word) (PDF) |
| Samples |
| Sample consent forms can be found on our Model Consent Forms page. |
| Sample of Telephone Screening Script (Word) (PDF) |
| Sample Introductory Script (PDF) |
| Studies involving the Use of Radiation |
| Application for the Research use of Ionizing Radiation: HUSC-RSC FORM 1001 (Word) (PDF) |
| Instructions for Form 1002, Research use of Non-Approved (FDA) Radioactive Drug: HUSC-RSC FORM 1002 (Word) (PDF) |
| Application Form for the Research use of a Non-approved (FDA) Radioactive Drug: HUSC-RSC FORM 1002 (Word) (PDF) |
| Studies involving Gene Therapy |
| rDNA Application Process (http://www.rcco.pitt.edu/rdna) |
| Documentation Forms |
| Child Form |
| Department of Defense Form |
| Device Documentation Form |
| Documentation of Expedited Review |
| Fetal Tissue Form |
| Hippa Waiver of Authorization |
| IND or IDE Checklist |
| International Checklist |
| Neonate Form |
| Pregnancy Form |
| Prisoner Form |
| Proxy Form |
| Unanticipated Problem Checklist |
| Waiver of Consent & HIPAA for Retrospective Study |
| Waiver of Consent to Identify Subjects |
| Waiver of Emergency Research |
| Waiver of HIPAA Exempt |
| Waiver of HIPAA for Recruitment |
| Waiver of Informed Consent |
| Waiver to Obtain a Signed Consent |