Forms

Forms are provided in Rich Text Format (.doc or .rtf ), Adobe Reader format (.pdf ) or both.  To download a form, click on the appropriate icon.

If you do not have the Adobe Reader, you may download it free from Adobe's Web Site.

If you have any questions about these forms, please contact us at OHRP@mcg.edu or 706-721-1478.

Initial Forms:
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Form #	Description	Links	Version Date
HAC 100	Clinical Study Document Cover Sheet		10/12/2009
HAC 101	Protocol Information		10/12/2009
HAC 101C	Sub-Investigator Continuation Sheet		10/12/2009
HAC 101EMG	Emergency Exemption from Prospective HAC Approval		1/28/2005
HAC 103	Human Biological Specimens for Genetic Research		7/9/2007
HAC 104	Research Medication Data Sheet		12/28/2007
HAC 105	Investigational Device Information Sheet		12/28/2007
HAC 112P	Request for Sponsor/CRO		2/18/2009
ITSS	Human Research-Request for Protected Space Log-in required		August 2009
OHRP	OHRP Ancillary IRB Review Form (To be submitted to OHRP only if you are using Chesapeake Research Review or National Cancer Institute Central IRB (CIRB), to review your protocol.)		10/7/2009

 

Ongoing Forms:

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Form #	Description	Links	Version Date
HAC 107	Clinical Study Continuation Request (Contact your HAC specialist to obtain this form.)
HAC 110URE/SAE	Unexpected and Related Adverse Event (URE)/Serious Adverse Event (SAE)		6/23/2008
HAC 113	Amendment Submission Form		10/12/2009
HAC 120PDV	Protocol Deviation/Violation Report Form		7/9/2007
OHRP	Research Self Assessment		7/09/2007

 

Termination Forms:

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Form #	Description	Links	Version Date
HAC 111	Final Report		1/28/2005

 

HAC Members:

	Description	Links	Version Date
1	HAC Reviewers Checklist		4/29/2008
2	HAC Checklist for Exempt Review		8/13/2008
3	HAC Checklist for Expedited Review		12/17/2007
4	HAC Checklist for Amendments		1/22/2008
5	Checklist for Vunerable Populations		12/31/2007
6	ICD Elements of Disclosure		9/07/2008
7	Checklist of Criteria to Waive or Alter the Requirement to Obtain Informed Consent		12/31/2007

 

Miscellaneous Forms:

Form #	Description	Links
1	New Research Faculty Transition Form
2	Training Requirements Checklist
3	Individual Investigator Agreement (IIA)

 

 Version 10-Nov-2009 , revised 12/18/07, 1/10/08, 3/4/08, 10/07/2009