Allegheny College IRB
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Incident Report
Researchers are required to file a report, using this form, for any incident occurring in the course of the research. A
report should be filed with the IRB for any major departure from an approved procedure or for any event resulting in
physical injury or psychological distress regardless if the injury was directly related to the research as long as it
occurred during the research. Moreover, the researcher has the responsibility of informing the participant(s) of the
contact information for the chair of the IRB.
Date and Time of the incident:
Description of the incident
Action(s) taken by the researcher
If there were no reportable incidents during the conduct of the research, the PI should file the following
statement at the conclusion of data collection.
There were no reportable incidents during the conduct of the research.
Principal Investigator (PI) __________________________________ Telephone _________________
Email __________________________________
Date Submitted _____________________________
Faculty Supervisor (if the PI is a student) _____________________________________ Telephone
____________________
Email ______________________________________________________________________________