10-CBA Delegation of Responsibility & Staff Signature Log CIBMTR CENTER # CENTER NAME PI Name: Designee Full Name Title Designee Designee Signature Delegated Effective End # of years Completion date of clinical Human Subjects Initials Activities Date Date (printed) (PI, Sub-I, coordinator, data research Protection training (see codes manager, etc.) experience below) Study Activity Codes: Medical History/ Physical Exam (Patient Care) Recruiting/screening Study form Completion (including unscheduled forms) Drug Dispensing/Accountability Consenting/enrollment Maintaining study files Query Resolution Data collection (direct subject contact) Other-specify Adverse Event Assessment (Physician only)
10-CBA Delegation of Responsibility & Staff Signature Log CIBMTR CENTER # CENTER NAME PI Name: Designee Full Name (printed) Title (PI, Sub-I, coordinator, data manager, etc.) Designee Initials Designee Signature Delegated Activities (see codes below) Effective Date End Date # of years clinical research experience Completion date of Human Subjects Protection training Study Activity Codes: Medical History/ Physical Exam (Patient Care) Drug Dispensing/Accountability Query Resolution Recruiting/screening Consenting/enrollment Data collection (direct subject contact) Adverse Event Assessment (Physician only) Study form Completion (including unscheduled forms) Maintaining study files Other-specify
10-CBA%20DoA%20log-template.docx