Tulane University Institutional Biosafety Committee (IBC) Request for Amendment to Approved Protocol

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Tulane University
Institutional Biosafety Committee (IBC)
Request for Amendment to Approved Protocol
Principal Investigators (PIs) must submit this form to request changes or modification to a previously
approved IBC protocol. It is the responsibility of the PI to notify the IBC of changes to an approved
protocol. The original protocol approval will expire at the previously approved expiration date (original 3
year approval). Some changes to the protocol may require submittal of a new protocol or additional
information. Send this form by e-mail to [email protected]
Approved IBC protocol Number:
Date of approval:
Protocol title:
Principal Investigator:
Department :
Telephone :
E-mail
School:
Check the items that will differ from your approved protocol:
1. Project title
2. Location of project
3. Biosafety level
4. New personnel
5. Use of recombinant DNA
6. Type of infectious agents
7. Use of other biological reagents (blood, body fluids, cell lines):
8. Use of transgenic plants or animals
9. Use of Select Agents or toxins
10. Change in human studies
11. Other
Provide details of the intended changes. The IBC will determine if your proposed changes can be done
via an amendment or require submission of a new protocol (add additional pages if necessary)
Signature of PI: ___________________________
IBC Office, 1430 Tulane Avenue
Mail Box TW-5
Phone: 988-0300; Fax: 988-0370
Version, June ,2012
Date:
Page 1
For IBC use only:
Protocol number:
Amendment number:
This amendment is: APPROVED :
NOT APPROVED :
Signature of IBC: _________________________ __
IBC Office, 1430 Tulane Avenue
Mail Box TW-5
Phone: 988-0300; Fax: 988-0370
Version, June ,2012
Date:
Page 2
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