SECTION 2 – (For Institute Ethics Committee (IEC)-Human Studies) Proforma to be submitted to the JIPMER Institute Ethics Committee (Human Studies) for MD/MS/MSc/DM/M.Ch/Fellowship/MPH Students (for Thesis or Dissertation) Title of the project: Name and department/address of the investigator: Name of Faculty (Guide/Co-guide) with designation & department: Date of approval by PG research monitoring committee: Ethical issues involved in the study: less than minimal risk/ minimal risk/ more than minimal risk to the subjects (for guidance [Along with the level of risk, the risks please consult ICMR guidelines - at JIPMER website) should be discussed in detail] Benefit of the study: Details of Informed Consent Process: Who will take the informed consent? When will the informed consent be taken? How will the informed consent be will the informed consent be taken? Do you need exemption from obtaining Informed Consent from study subjects - if so give justifications. Whether Consent forms in English and in local language are enclosed? (if the consent form in local language is not applicable, appropriate explanations must be provided) 10. Documents attached Review Exemption Application Form (if applicable) Brief CV of all faculty investigators (guide/co-guide) (including no. of projects with him/her) - Needed for all Investigators for each project separately For student projects, the guide should give a signed statement on a separate sheet with details of the project proposal that take full responsibility and accountability for “I planning, execution and adverse events occurring during the study. The data collected and records will be retained by me for a period of three years”. Others 11. Conflict of interest for any other investigator(s) (if yes, please explain in brief)
SECTION – 2 (For Institute Ethics Committee (IEC)-Human Studies) Proforma to be submitted to the JIPMER Institute Ethics Committee (Human Studies) for MD/MS/MSc/DM/M.Ch/Fellowship/MPH Students (for Thesis or Dissertation) Title of the project: Name and department/address of the investigator: Name of Faculty (Guide/Co-guide) with designation & department: Date of approval by PG research monitoring committee: Ethical issues involved in the study: less than minimal risk/ minimal risk/ more than minimal risk to the subjects (for guidance please consult ICMR guidelines - at JIPMER website) [Along with the level of risk, the risks should be discussed in detail] Benefit of the study: Details of Informed Consent Process: Who will take the informed consent? When will the informed consent be taken? How will the informed consent be will the informed consent be taken? Do you need exemption from obtaining Informed Consent from study subjects - if so give justifications. Whether Consent forms in English and in local language are enclosed? (if the consent form in local language is not applicable, appropriate explanations must be provided) 10. Documents attached Review Exemption Application Form (if applicable) Brief CV of all faculty investigators (guide/co-guide) (including no. of projects with him/her) - Needed for all Investigators for each project separately For student projects, the guide should give a signed statement on a separate sheet with details of the project proposal that “I take full responsibility and accountability for planning, execution and adverse events occurring during the study. The data collected and records will be retained by me for a period of three years”. Others 11. Conflict of interest for any other investigator(s) (if yes, please explain in brief)
Integrated-form-for-PG-research-protocols-Version-2.0-dated-22nd-October-2016_0.docx