Dual REB Oversight Agreement (Canada)

Form: Reliance Agreement (Dual REB Oversight (Canada))
Document No.: / Edition No.: / Effective Date: / Page:
HRP-231 / 001 / 30 Jun 2016 / Page 1 of 2
Complete this form when a local REB has dual jurisdiction over this research site.
You must submit a typed version of this form (except for the signature block) to prevent errors and delays due to legibility problems.
Blank & incomplete answers will result in delayed reviews
If you have questions about the use of this form, please contact WIRB at 1-800-562-4789 or email
Research Protocol:
Protocol #:
Protocol Title:
Sponsor Name:
IRB Tracking #: / (if known)
Principal Investigator:
Name:
Organization:
Name:
FWA #: / (if organization has an FWA)
Contact Information for Organization:
Name:
Title:
Address 1:
Address 2:
City: / State/Province:
Zip/Postal Code: / Country:
Phone: / Email:

Pursuant to federal regulations, Western IRB (WIRB) (IRB registration number IRB00002354) (“Central REB”), and the Organization’s REB agree to share oversight of the Research Protocol. Both REBs agree to the following conditions for shared oversight:

1. If either REB makes a finding of serious or continuing non-compliance, or suspends or terminates the research, it will notify the other REB of these actions and provide a summary of the reasons.

2. If either REB receives a subject complaint relevant to the oversight of the other REB, the REB will notify the other REB and provide information regarding the subject complaint.

3. Both REBs will approve the consent form, the protocol, and other aspects of the research. Both REBs will provide continuing oversight of the research for the duration of the study.

4. Both REBs will follow their own written procedures.

For Central REB / For Organization
Signature / Signature
Printed Name / Printed Name
Title / Title
Date / Date