IRB Forms
| General Forms |
| Checklist used by IRB for Review of Proposals (Word) |
| IRB Cover Sheet (Word) (PDF) |
| Industry Sponsored Fee Information Sheet (Word) (PDF) |
| Industry Sponsored Fee Information Sheet for Children's Hospital Studies (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) |
| 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 Web Page |
Adverse Event Reporting/Unanticipated Problems |
| IRB Internal Adverse Event Report Form for the Investigator (Word) (PDF) |
| IRB External Adverse Event Report Form for the Investigator (Word) (PDF) |
| IRB Adverse Event Reviewer Form for the Reviewer (Word) (PDF) |
| Unanticipated Problems Involving Risks to Subjects or Others during Research Study - Not an AE (Word) (PDF) |
| Samples |
| Sample of Informed Consent Form: Consent to Act as a Subject in a Research Study (Word) (PDF) |
| Sample of Informed Consent Form: HIPAA Authorization Form for Sharing Health Information (Word) (PDF) |
| Sample of Informed Consent Form: HIPAA Authorization Form for Sharing Additional Health Information - A Sample Addendum (Word) (PDF) |
| Sample of Telephone Screening Script (Word) (PDF) |
| Sample Research Registry Protocol (Word) (PDF) |
| Sample Research Registry Informed Consent (Word) (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) |