Research Ethics Board

Study Completion/Termination Form

1.  Submit a typed, copy of this form with original signature to the REB office for processing once the REB file is eligble for termination.
2.  Please attach a copy of a study summary or completion report.
3.  Please e-mail an electronic copy of submission materials to
4.  Send a hard copy to attn: Alexandra Chappell room 744 790 Bay Street

Study Information

Study Title:

WCH REB #:

Expiry date of REB Approval:

Site Principle Investigator:

Sponsor/Funder:

Summary of Termination/ Study Completion

All participant recruitment at this site is complete / Yes No N/A
All participant follow-up is complete / Yes No N/A
All analyses using identifiable or coded data are complete / Yes No N/A
Letters of Appreciation to Research Participants have been sent / Yes No N/A
The sponsor has conducted a close-out visit (industry-sponsored studies) / Yes No N/A

** If ‘No’ to any of the above, the this study should remain open. Please complete an Annual Renewal Form instead or provide an explanation below:

Explanation:

Premature termination of the study by investigator or sponsor
Reason for premature termination:
Termination date (dd/mm/yyyy): / Total enrolled at WCH:
Study completed (i.e. no further participants involvement, completed data collection, data analysis and transfer completed, no further involvement of PI at the site with any aspect to the study)
Date closed (dd/mm/yyyy): / Total participants enrolled at WCH:
Attach a copy of final report, if available (i.e. sponsor close-out report, published paper, submitted abstract).

Version Date: 25-June-2013 Page 2 of 2 Study Completion/Termination Form

Women’s College Hospital REB – 790 Bay Street, Room 744, Toronto ON M5G 1N8

Telephone: 416-351-2535 email:

Final study report attached

Terminate REB file

WCH Principal Investigator’s Signature

I confirm that all study-related activity for this research study at Women’s College Hospital is now complete. I request that the Women’s College Hospital REB file on this study for this site be officially closed:

______

Print Name Signature Date (dd/mmm/yyyy)

RETURN TO:

Attention: REB Coordinator

WCH Research Ethics Board

790 Bay Street,

Toronto ON M5G 1N8

Ph: 416-351-3732 x 2723
email:

FOR OFFICE USE ONLY:

Acknowledgement of Study Closure

______

REB Chair (or delegate) Signature Date (dd/mmm/yyyy)

Version Date: 25-June-2013 Page 2 of 2 Study Completion/Termination Form

Women’s College Hospital REB – 790 Bay Street, Room 744, Toronto ON M5G 1N8

Telephone: 416-351-2535 email: