Modification Short Form

Modification Short Form

For use in help determining changes in risk.
Principal investigator

First NameLast Name
Email
example@example.com
IRB protocol title
IRB protocol number
Do you need to make any changes due to restrictions caused by COVID-19?

YesNo
Will this be a temporary change during the crisis or is the change permanent?

Temporary changePermanent change
What change(s) will you make? Please select all that apply:

Change in the protocol titleChange in key personnelChange in populations/population groupsChange in method of recruiting to remote/virtual meansChange in location to remote/virtual meansChange in method of collecting data to online/virtual meansOther
Please provide a description of the modification(s). Also include some information about the technology to be used (ex. WebEx)
Thank you for your submission. We will review your modification and get back to you with a risk determination and any further procedure(s) that may be needed.
Should be Empty: