Clinical Epidemiology and Biostatistics Unit (CEBU) by deafeningbuzz

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									                             Clinical Epidemiology and Biostatistics Unit (CEBU)

                                    Project Review Form (for Ethics applications)

Please complete this form and obtain appropriate CEBU comments and signature if you have formally
    consulted anyone in CEBU in relation to a project that you are submitting for ethics approval.

The purpose of the form is to provide a brief “official” statement on whether a particular research project has been
discussed with a member of CEBU. It is intended to be used with applications to the Ethics in Human Research
Committee, to provide those involved in the ethical review process with clear information about the current and planned
extent of CEBU involvement.


Project title: _______________________________________________________________________

                      ____________________________                             EHRC application number, if known:


Investigator names:                          1) _________________________                            2) ___________________________

                                             3) _________________________                            4) ___________________________

                                             5) _________________________                            6) ___________________________

Department / Research Group:                            ____________________________________________________

MCRI Theme, if appropriate:                             ____________________________________________________




For CEBU use

Protocol version last seen:                             number ______________                                   date ____ / ______ / 20___
[should be clearly indicated on any document provided for CEBU comment/review]


Brief opinion/comments on project:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

What input by CEBU has been provided already? ___________________________________________

What has been agreed for the future? _____________________________________________________


CEBU staff member name: ______________________________________


Signature:                                                                                                      Date: ____ / _____ / 20___
Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Parkville, Victoria 3052, AUSTRALIA.
PHONE (03) 9345-6368 FAX (03) 9345-6000 EMAIL: donna.desair@mcri.edu.au

								
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