Site Staff Signature Sheet by coryelJudie

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									                                                                                                             Delegation Log
           PRINCIPAL INVESTIGATOR NAME                                                                      CENTRE NAME                                                                            STUDY NUMBER:/NAME/EUDRACT No.



                                                                                                                                                             **Key Delegated Study Task(s)                      Duration                      Investigator Signature
      Print Full Name & Title                                Signature                     Initials                      *Study Role                           See Examples Listed Below
                                                                                                                                                                                                       From:             To:




*Identification of study role includes but is not limited to sub-investigators, study nurses, pharmacist (when appropriate) and data recorders. List individuals delegated significant study-related tasks (ICH GCP 4.1.5). Signatures/Initials required for all persons
authorised to make entries and/or corrections to Case Report Forms (ICH GCP 8.3.24)

** Identify key study tasks when delegated by the investigator. Examples of key delegated study tasks could include:
1             Obtain Informed Consent            6             Investigational Product Accountability         11        Archiving                                                             16        Other______________________
2             Obtain Medical History             7             CRF Completion                                 12        Other______________________                                           17        Other______________________
3             Perform Physical Exams 8           CRF Signature                                       13       Other______________________                                        18           Other______________________
4             Inclusion/Exclusion Assessment     9             Data Query Completion                          14        Other______________________                                           19        Other______________________
5             Drug Dispensing                    10            Data Query Signature                           15        Other______________________                                           20        Other______________________




SSSS 16 Aug01                                                                                                                                                                                                           Page ____ of ____

								
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