Delegation of Authority Log
Protocol
Staff Name
Principal Investigator
Role
Responsibilities
Start Date
End Date
PI Initial and
Date
PI Delegation of Authority Agreement
Protocol Title
Protocol Number
Sponsor
Principal Investigator
Site Number
I, the Principal Investigator for the above listed study, have delegated responsibilities to the individuals included. Individuals with
completed tasks listed on the log will be working within their scope of their position.
Delegated Tasks Start Date: ____________________
Signature of Principal Investigator: _______________________________________
Date: ____________________