REVIEWER CHECKLIST
I NVESTIGATIONAL D EVICE E XEMPTION (IDE) D ETERMINATION
PROTOCOL TITLE:
PRINCIPAL INVESTIGATOR: IRB REFERENCE #:
SPONSOR/FUNDING SOURCE:
IRB Panel: A B Meeting Date:
Reviewer Initials: Primary Reviewer
When research is conducted to determine the safety or effectiveness of a device, ONE of the following conditions must be true:
•
•
•
The device has an IDE issued by the FDA
The device fulfills the requirements for an abbreviated IDE
The device fulfills one of the IDE exemption categories
Verification of IND Status
Does the device have an IDE issued by the FDA?
If yes, is the IDE valid?
(The Investigator’s Brochure may not be used for this purpose).
Only one of the following must be “Yes”:
 The number is imprinted on the sponsor’s protocol.
 The number is noted in written correspondence from the sponsor.
 The number is noted in written correspondence from the FDA (required if the Investigator holds the IDE
Assessment of Requirement for an IDE
Yes No
Yes No
Yes No
Yes No
Does the device fulfill the requirements for an abbreviated IDE?
(21 CFR 812.2(b)(1))
For this condition to be met, all answers related to this condition must be “Yes”.
The device is not a banned device.
Yes No
The sponsor labeled the device in accordance with 21 CFR 812.5.
Yes No
N/A
(rev. 7/4/11)

The sponsor will obtain IRB approval of the investigation after presenting the reviewing IRB with a brief explanation of why the device is not a significant risk device, and maintains such approval.
Yes No
The sponsor will ensure that each investigator participating in an investigation of the device obtains from each subject under the investigator’s care consent under 21 CFR 50 and documents it, unless documentation is waived.
Yes No
The sponsor will comply with the requirements of 21 CFR 812.46 with respect to monitoring investigations.
Yes No
The sponsor will maintain the records required under 21 CFR 812.140(b)(4) and (5) and make the reports required under 21 CFR §812.150(b) (1) through (3) and (5) through (10).
Yes No
The sponsor will ensure that participating investigators will maintain the records required by 21
CFR 812.140(a)(3)(i) and make the reports required under 812.150(a) (1), (2), (5), and (7).
Yes No
The sponsor will comply with the prohibitions in 21 CFR 812.7 against promotion and other practices.
Yes No
Does the device fulfill one of the IDE exemption categories?
(21 CFR 812.2(c)) N/A
For this condition to be met, only one main items below must be answered “Yes”.
The device, other than a transitional device, was in commercial distribution immediately before May
28, 1976, and will be used or investigated in accordance with the indications in labeling in effect at that time.
Yes No
The device, other than a transitional device, was introduced into commercial distribution on or after
May 28, 1976, the FDA determined the device to be substantially equivalent to a device in commercial distribution immediately before May 28, 1976, and the device will be used or investigated in accordance with the indications in the labeling FDA reviewed under subpart E of part
807 in determining substantial equivalence.
Yes No
The device is a diagnostic device, and the sponsor complies with applicable requirements in 21 CFR
§809.10(c) and the testing (to be met, all of the following must be “Yes”):
 Is non-invasive. Yes No
 Does not require an invasive sampling procedure that presents significant risk. Yes No
 Does not introduce energy into a subject. Yes No
 Will not be used as a diagnostic procedure without confirmation of the diagnosis by another, medically established diagnostic product or procedure. Yes No
The device is undergoing consumer preference testing, testing of a modification, or testing of a combination of two or more devices in commercial distribution, and the testing is not for the purpose of determining safety or effectiveness and does not put participants at risk.
Yes No
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The device is intended solely for veterinary use.
Yes No
The device is shipped solely for research on or with laboratory animals and labeled in accordance with 21 CFR §812.5(c).
Yes No
The device is a custom device as defined in 21 CFR §812.3(b), unless the device is being used to determine safety or effectiveness for commercial distribution.
Yes No
FINAL IRB DETRMINATION
An IDE is required for this investigation. Proper documentation has been received.
An IDE is not required for this investigation (an FDA exemption letter has been received).
The IRB feels an IDE is not required for this investigation; however, the investigator should formally request an exemption determination from the FDA.
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