Jeg (Hovedutprøver) Delegerer Med Dette Følgende Studierelaterte Oppgaver Til Angitte
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DELEGATION LOG (TASKS DELEGATED FROM Responsible Researcher at Institution) Clinical Interventional Study
Study: (Title and number) Project Manager: Centre No: (Multi centre study) Responsible Researcher at Institution: Task Codes**:
Role*:
A. Obtain Informed Consent H. Report SAE O. Review lab results
Reseponsible Researcher (RR) Other:______B. Assess inclusion-exclusion Criteria I. CRF completion, query resolution P. Allocate treatment/randomisation
Investigator (INV) Other:______C. Record Medical History J. Sign off CRF and queries Q. Unblind, if applicable
Study Nurse (SN) Other:______D. Record Concomitant Medication K. Lab sampling and handling R. Other:______
Lab personnel/bioengineer Other:______Role Name Initials Signature Delegated Protocol- Start RR Stop date RR (pinted) tasks specific date con (dd.mm.åååå) confirmation (from code list) training (dd.mm.yy fir (initials) received yy) ma tio n (init ials )
RR Yes No Role Name Initials Signature Delegated Protocol- Start RR Stop date RR (pinted) tasks specific date con (dd.mm.åååå) confirmation (from code list) training (dd.mm.yy fir (initials) received yy) ma tio n (init ials )
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No DELEGATION LOG (TASKS DELEGATED FROM Responsible Researcher at Institution) Clinical Interventional Study
Study: (Title and number) Project Manager: Centre No: (Multi centre study) Responsible Researcher at Institution: Task Codes**:
Role*:
A. Obtain Informed Consent H. Report SAE O. Review lab results
Reseponsible Researcher (RR) Other:______B. Assess inclusion-exclusion Criteria I. CRF completion, query resolution P. Allocate treatment/randomisation
Investigator (INV) Other:______C. Record Medical History J. Sign off CRF and queries Q. Unblind, if applicable
Study Nurse (SN) Other:______D. Record Concomitant Medication K. Lab sampling and handling R. Other:______
Lab personnel/bioengineer Other:______Role Name Initials Signature Delegated Protocol- Start RR Stop date RR (pinted) tasks specific date con (dd.mm.åååå) confirmation (from code list) training (dd.mm.yy fir (initials) received yy) ma tio n (init ials ) Role Name Initials Signature Delegated Protocol- Start RR Stop date RR (pinted) tasks specific date con (dd.mm.åååå) confirmation (from code list) training (dd.mm.yy fir (initials) received yy) ma tio n (init ials )
Yes No
Yes No
Yes No
Yes No
To be signed by RR at the completion of the study to confirm all information above is correct (Last page) Date Responsible Researcher, printed name Responsible Researcher, signature