Royal North Shore Hospital
Institutional Biosafety Committee
Application Form for an Amendment to an Approved Research Project
Instructions
1. A cover letter is not required with this form
2. The application for amendment form must be signed off by the Chief Investigator
3. Please provide an amended version of the original IBC Application with all changes to
the protocol underlined and bolded.
4. This form must be submitted in the following manner:
Soft Copy: NSLHD-Research@health.nsw.gov.au
Hard Copy: 1 signed original
Institutional Biosafety Committee Secretariat
Research Office
Level 13, Kolling Building
Royal North Shore Hospital
Pacific Highway, St Leonards, NSW
You are reminded that the proposed amendment must not be implemented without prior
written approval from the IBC
IBC Protocol No:
Date of approval letter:
Chief Investigator:
Other Investigators:
Protocol Title:
Document
Authorisation
Document Owner:
Document author:
Research Office
Gretta Quilter
Authorised by
Document Created:
IBC Committee
May 2013
Stamp
Contact Number:
Ext. 64590
Last Modified:
25/10/2013
1
Description of amendment
and relevant reference
numbers
Reason for requesting
amendment
Additional Documentation
[briefly summarise the relevant details relating to the amendment]
[Note: if you are addding or removing personnel you must complete
a Change in Personnel Form and submit this with your Amendment]
[summarise the relevant details relating to the amendment; e.g.
addition of GMO etc]
[list all amended documents submitted including updated versions
and dates as well as any additional attachments related to the
amendment here]
DECLARATION
I agree that the above information is accurate, and that the project will continue in
accordance with the original IBC approved protocol dated_________________________
and any approved amendments.
Signature of Chief Investigator/Co Investigator and Date:-
OFFICE USE ONLY
Previous progress report/s received?
Yes/No
Document
Authorisation
Document Owner:
Document author:
Research Office
Gretta Quilter
Authorised by
Document Created:
IBC Committee
May 2013
Stamp
Contact Number:
Ext. 64590
Last Modified:
25/10/2013
2