Delegation of Authority Log
Study Title:
IRB #:
Sponsor:
Study team
member
Principal Investigator:
Study Site:
Title
Signature
Initials
Start date
Stop date
Activities
(refer to code list below)
Activity codes:
A
E
I
M
Informed consent process
Obtain medical history
Investigational product accountability
IRB submissions
B
F
J
N
Eligibility assessment
Concomitant medication review
Investigational product storage
Shipment and handling of samples
C
G
K
O
CRF/eCRF entry
Perform physical exam
AE grading and attribution
Essential documentation
D
H
L
P
CRF/eCRF signatures
Review lab and procedure results
AE reporting to sponsor and/or IRB
Other__________________
I have delegated the identified duties and will directly supervise the named personnel in the performance of protocol requirements.
Principal Investigator Signature: _________________________________________
Investigator must sign and date after changes to the research personnel.
PI signature:
PI signature:
PI signature:
Version: 2/2014
Date:
Date:
Date:
Date: ____________________