Initial Review Tool
Research Service – Louis Stokes DVA Medical Center

This is a template. You can tab through the entire document and address each query. When done, go to Review, and Stop Protection, - This will allow you to navigate anywhere within the form. To check a box, place your cursor to the left of the box, right click → Properties → Default value → click on O not checkedOR O checked.

Please note that this is an open review process. In the spirit of supporting our Principal Investigators, we would like to encourage you to share your written and/or verbal comments with the Investigator, and meet with them to clarify issues if warranted. We appreciate the service you are providing and the time you are contributing in reviewing this proposal.

Proposal Title:

Principal Investigator:

Reviewer Name:

Reviewer Phone Number:

Reviewer Email:

Relationship to Principal Investigator:

Mentor

Service Line Chief

Principal Investigator within the LSCDVAMC

Non-LSCDVAMC Principal Investigator

Other – Describe:

A.CONFLICT OF INTEREST / Yes / No
  1. Do you, the reviewer, have a conflict of interest in reviewing this research proposal?

If “Yes” please contact the R&D Committee Coordinator, Christina Bennett (phone 216-791-3800 x3646; email ) before reviewing this proposal.
  1. Are you aware of any conflicts of interest on the part of the principal investigator in performing this research?

Please mark “Yes” or“No”for each of the following questions. Please explain any items marked, “No” in the area provided. Additional comments are welcome

B.WORK PROPOSED / Yes
  1. Is the methodology outlined in this research proposal appropriate for this research question?

  1. Are the proposed experiments feasible?

  1. Is the experimental plan adequate to test the hypothesis and answer key questions?

C.RESOURCES / Yes / N/A
  1. Are the Principal Investigator and study staff (if applicable) adequately qualified to complete this project?

  1. Are adequate resources available to complete this project?

  1. Is the budget provided for this project adequate to support the costs of this research?

  1. Are the required facilities and equipment in available?

4a.(If Item 4 is “N/A”) Will the required facilities or equipment be in place before the research commences?
  1. Is it feasible to conduct the study at the Louis Stokes Cleveland DVA Medical Center?

  1. Does the investigator have sufficient time to conduct and complete the research?

D.SIGNIFICANCE / Yes
  1. Does this research proposal have scientific merit?

  1. Is the research relevant to the VA patient care mission?

  1. Is the importance of the knowledge to be gained clearly and accurately identified?

E.COMMENTS (Please address any items marked “No” or Unsure here)

Based on the findings above you recommend this proposal be:

Approved andforwarded to the appropriate Research and Development Subcommittee (IACUC, IRB, and/or SRS) for review and action

Revised and re-reviewed prior to Research and Development Subcommittee (IACUC, IRB, and/or SRS) review.

Disapproved (please provide comments above)

Proposals that have not adequately met the criteria above will be returned to the Principal Investigator and his/her reviewers.

I attest that I have reviewed this proposal in its entirety and that to the best of my knowledge my findings above are accurate.

Reviewer Signature

REVIEWER’S SIGNATUREDATE

Version update 12-28-2017