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1、IRB Template Rev. Date: 9-1-12IRB Use Only Do Not Revise or DeleteVCU IRB STUDY PERSONNEL ROSTER(for Expedited and Full Board Research)Principal Investigator:vcu email:Research Coordinator:vcu email:vcu irb #:Title of Project: STUDY PERSONNEL ROSTER INSTRUCTIONS: Definitions and detailed instruction
2、s for form completion and submission are located at the end of this form. Please review the instructions carefully before completing, revising, or submitting this form. STUDY PERSONNEL ROSTERFirst NameLast NameCOI Investigator*Non-VCU Affiliate - COI Policy Adherence (See Instructions)*Role in Study
3、 - (entry should match information on Study Personnel Information and Change Form)Date Addition Proposed to IRB:Date Removal Proposed to IRB:YESNOVCU PolicyNon-VCU Affiliates Institutional Policy1)If Other, list: 2)If Other, list: 3)If Other, list: 4)If Other, list: 5)If Other, list: 6)If Other, lis
4、t: 7)If Other, list: 8)If Other, list: 9)If Other, list: 10)If Other, list: 11)If Other, list: 12)If Other, list: 13)If Other, list: 14)If Other, list: 15)If Other, list: 16)If Other, list: 17)If Other, list: 18) If Other, list: 19)If Other, list: 20)If Other, list: Roster Version Date: (Insert upda
5、ted version date) STUDY PERSONNEL ROSTER CONTINUATION PAGE (if needed)First NameLast NameCOI Investigator*Non-VCU Affiliate - COI Policy Adherence (See Instructions)*Role in Study - (entry should match information on Study Personnel Information and Change Form)Date Addition Proposed to IRB:Date Remo
6、val Proposed to IRB:YESNOVCU PolicyNon-VCU Affiliates Institutional Policy21)If Other, list: 22)If Other, list: 23)If Other, list: 24)If Other, list: 25)If Other, list: 26)If Other, list: 27)If Other, list: 28)If Other, list: 29)If Other, list: 30)If Other, list: 31)If Other, list: 32)If Other, list
7、: 33)If Other, list: 34)If Other, list: 35)If Other, list: 36)If Other, list: 37)If Other, list: 38) If Other, list: 39)If Other, list: 40)If Other, list: 41)If Other, list: 42)If Other, list: 43)If Other, list: 44)If Other, list: 45)If Other, list: 46)If Other, list: 47)If Other, list: 48)If Other,
8、 list: 49)If Other, list: 50)If Other, list: Page 4STUDY PERSONNEL ROSTER INSTRUCTIONS(The following instructions do not need to be submitted to the IRB)GENERAL INSTRUCTIONSo The Personnel Roster is to list all VCU project personnel who are engaged* in this research protocol (including the Principal
9、 Investigator), as well as all non-VCU affiliated individuals (affiliated with another institution/site) and Independent investigators (those with no institutional affiliation) who are also engaged but do not have IRB approval for this protocol from their own institution. For those non-VCU individua
10、ls who are affiliated with another institution/site but do not have IRB approval from their own institution, an IRB Authorization Agreement must be put in place if the study involves a DIRECT FEDERAL AWARD to VCU (or application for such) (see the VCU IRB Written Policies and Procedures (WPPs), #XVI
11、I-6; Involving Non-VCU Institutions in VCU Human Subjects Research at http:/www.research.vcu.edu/irb/wpp/flash/XVII-6.htm). For independent investigators (not affiliated with VCU or another institution), an Independent Investigator Agreement must be put in place if the study involves a DIRECT FEDERA
12、L AWARD to VCU (or application for such) (see WPP # XVII-15; Involving Independent Investigators in VCU Human Research at http:/www.research.vcu.edu/irb/wpp/flash/XVII-15.htm). All non-VCU affiliates and Independent Investigators on the Personnel Roster must also meet the VCU IRB education requirements. If either Agreement is required, complete the appropriate template Agreement and include it with the IRB submission.o The Personnel Roste
