IBC Personnel Amendment

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ADD/REMOVE PROTOCOL PERSONNEL FORM
The University of Texas at El Paso
IBC Protocol# :
Principal Investigator:
Protocol Title:
ADD Personnel - except Principal Investigator
Job Experience:
Name
Role(s): (list all that apply)
UTEP ID#
Department
(Last, First)
Ex: Doe, John
12-
**Co-Investigator, Fellow, Student, Faculty, Staff, Outside Collaborator**
12345678
Biological Sciences
Staff- Individual has X amount of experience specific to the Y procedures that he/she
will be conducting under this protocol
Required for all new personnel
Each individual must be current with Basic Laboratory Safety, Occupational Health Questionnaire and Biosafety/Blood
borne Pathogens safety classes before this amendment can be processed. Safety classes can be arranged through the
EH&S website: http://ehs.utep.edu/
* I understand that the personnel to be added must not begin work on this protocol until approval is received from the
Institutional Biosafety Committee.
* The personnel to be added are fully qualified to perform the related duties under this protocol or will be trained and
supervised by the Principal Investigator named above and will be given a copy of the protocol.
REMOVE Personnel – except Principal Investigator
Name (Last)
Name (First)
Reason(s) for Removal: graduated, medical reasons, etc…
Principal Investigator’s Assurance
I certify that the information provided in the application is complete and correct. As Principal Investigator, I have the ultimate responsibility for
the conduct of the research and the ethical performance of the project. I will comply with all NIH policies and procedures, as well as with all
applicable federal, state, and local laws regarding the conduct of the research.
I certify that I, and all key personnel, have completed the required initial and/or refresher CITI or Environmental Health & Safety trainings.
2015 Version
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