Research Proposal Clearance Form (RPCF) by pharmphresh30

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									                                       Research Proposal Clearance Form (RPCF)
                                                                                                                                   Research Office
                                                                                                         Level 6, Jane Foss Russell Building (G02)
                                                                                                                         NSW 2006 AUSTRALIA


This form is for University of Sydney employees or affiliates ONLY. It must be completed for ALL researchers employed by or affiliated with the
University of Sydney or applicants for Fellowships that will be administered by the University of Sydney. Complete all sections of this form for all
research grant proposals and submit to the Research Office with the completed grant application form.

CHIEF INVESTIGATOR 1:

Surname:                                                First Name:                                              Title:

School/Dept:

Mobile:                                                 Email:

Staff Number:                                           Gender: F / M                                            *Credit Share %:

If not USYD staff state type of appointment                Conjoint                 Clinical             Other (specify)

      SIGNATURE OF APPLICANT Chief Investigator 1:                                                     Date:
* Shared Credit Agreement: Additional income generated by this grant (eg. RIBG, IGS, RTS) will be shared equally by the University of
Sydney Schools/Departments of the Chief Investigators named on this grant unless otherwise nominated.

CHIEF INVESTIGATOR 2:

Surname:                                                First Name:                                              Title:

School/Dept:

Mobile:                                                 Email:

Staff Number:                                           Gender: F / M                                            Credit Share %*:

If not USYD staff state type of appointment                Conjoint                 Clinical             Other (specify)

       SIGNATURE OF APPLICANT Chief Investigator 2:                                                              Date:
If there are more than 2 Investigators on the project, please insert more rows here and copy table.


PROJECT GRANT                     Project title on this form must match title on ethics approval forms

Title of project

Name of granting body

Name of granting scheme
Proposed Start date         --/--/----           Proposed End date             --/--/----             Duration of project (years):

PROJECT CODES                    Codes and further information can be viewed at http://www.usyd.edu.au/ro/applications/classifications.shtml
 Fields of Research (2008)                                 Socio Economic Objective Code (2008)            ABS Statistics (must total 100%)
[FoR codes listing – click here]                           [SEO Codes listing – click here]                [ABS Descriptions – click here]
6 digit code               (must total 100%)                6 digit code  (must total 100%)                Pure Basic
                                                                                                               Strategic
                                                                                                               Applied
                                                                                                               Experimental
- non-2008 FoR/SEO codes cannot be accepted -PLEASE USE THE NEW CODES -




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                                                       Research Proposal Clearance Form (RPCF)
APPROVALS You must answer all questions in this section. The Project title on this form MUST match title on ethics/biosafety approval forms.
Please ensure your RIMS Project ID is quoted in the protocol form when requesting ethics and/or other clearances.

NOTE: Commencing 1 January 2008, the activation of research accounts will no longer be tied to ethics/other approvals being obtained. It remains
the responsibility of Chief Investigator/s to ensure that no work requiring approval is commenced until such approvals are in place.
HUMAN ETHICS - If your project involves the use of questionnaires/surveys, access to medical or other personal records, investigations of
human behaviour, routine testing of human subjects, the administration of drugs, chemical agents or vaccines, or any experimentation on human
beings you need ethics approval. When do you anticipate this approval being required?                     Date: _ _ / _ _ / _ _ _ _     NA
If ethics approval is already obtained, please attach a copy.                                                                                                       APPROVAL ATTACHED

ANIMAL ETHICS - If the project involves the use of animals you need ethics approval. When do you anticipate this approval being required?
                                                                                                                                                          Date: _ _ / _ _ / _ _ _ _                   NA
If ethics approval is already obtained, please attach a copy.                                                                                                       APPROVAL ATTACHED

BIOSAFETY - All applications for the use of genetically modified organisms (GMOs) are governed by legislation. Hazardous organisms also
require approval. Refer to the University Biosafety website http://www.usyd.edu.au/ohs/ohs_manual/bio_safety.shtml .
1. If the project involves GMOs you need IBC (Biosafety) approval. When do you anticipate this approval being required?
                                                                                                                                                          Date: _ _ / _ _ / _ _ _ _                   NA
           Is the facility where you will undertake the Project involving GMOs approved by the IBC?                                                                  YES                              NO
          If IBC (Biosafety) approval is already obtained, please attach a copy.                                                                                    APPROVAL ATTACHED
2. If the project involves the use of hazardous organisms you need IBC approval. When do you anticipate this approval being required?
                                                                                                                                                          Date: _ _ / _ _ / _ _ _ _                   NA
3. Does the project involve the use of carcinogenic or highly toxic chemicals?                                                                                              YES                       NO
   If YES complete and attach the Projects Involving Carcinogenic or Highly Toxic Substances Supplement                                                         SUPPLEMENT ATTACHED

RADIATION – If the project involves the use of ionising radiation you need approval. When do you anticipate this approval being required?
                                                                                                                                                          Date: _ _ / _ _ / _ _ _ _                   NA
If approval is already obtained, please attach a copy.                                      RADIATION SUPPLEMENT ATTACHED
Refer to the University Radiation Safety Requirements: http://www.usyd.edu.au/ohs/ohs_manual/radiation.shtml
A waste minimisation and management procedure must be in place before work commences.
APPROVAL FROM OTHER COMMITTEE - We will now accept non-University of Sydney ethics and biosafety approvals. When submitting
approval from another Committee, the protocol information must be accompanied by Notification of Non-University Approval and must be signed
by the Chief Investigator and the Head of School or appropriate delegated authority

                   WILL THE ABOVE APPROVALS BE SOUGHT FROM A NON-UNIVERSITY OF SYDNEY COMMITTEE? YES                                                                                                  NO
Name/s of external committees: .................................................................................................................................................................................
                                                                                                     NOTIFICATION OF NON-UNIVERSITY APPROVAL ATTACHED

INTELLECTUAL PROPERTY AND CONTRACT NEGOTIATION
The University asserts ownership of all intellectual property created by a staff member (with some exceptions) in accordance with the University of
Sydney (Intellectual Property) Rule 2002

Any projects with an industry partner will require a Partner Agreement. We strongly recommend that you discuss this with Sydnovate and your
partner at an early stage. The agreement will need to be signed before the project can commence and a research account created. Sydnovate is
responsible for negotiating and finalising the agreement.


APPROVAL BY HEAD/S OF SCHOOL/DEPT ON BEHALF OF THE DEAN:
(To be completed by the Dean, Head of School or other designated officer, if required at Faculty level).
I/We confirm the information above is true and that the project is appropriate to the general facilities of this/our school/dept/s. I/We accept
responsibility for ethical considerations and other approvals relating to this project. I/We am/are aware that the school/dept/s is responsible for any
severance payments to fixed-term staff employed on grants whose contracts are not renewed and/or any expenditure which exceeds project funding.
An appropriate account code will be requested if this eventuates.

The University of Sydney policy for indirect cost recovery is at http://www.usyd.edu.au/hr/policydev/indirect_cost_recovery_policy.pdf
                    If there are more than 2 Heads of School/Departments to sign, please insert more rows here and copy table.
SIGNATURE OF HEAD OF SCHOOL/DEPARTMENT 1                                SIGNATURE OF HEAD OF SCHOOL/DEPARTMENT 2
Name:                                                                                                   Name:



Signature:                                                          Date:                               Signature:                                                           Date:


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