Office of Research Administration – St. Michael's Hospital
Contract ID # _______________________
Contract Review Document Tracking Sheet (DTS)
Please complete the DTS and email the DTS, addendum (if applicable) and an electronic copy of the contract at
ResearchContracts@smh.ca. If you do not have an electronic copy of the contract please hand deliver hardcopies of the DTS,
addendum (if applicable) and Contract to April Kim at the address below:
SMH - Office of Research Administration – 250 Yonge Street – 6th Floor - Toronto, ON M5B 2L7 Ph: (416) 864-6060 Ext. 7852 Fax: (416) 864-6043
Date Submitted:
SMH Investigator:
Name:
Ext:
SMH Contact person for pick-up/questions:
Name:
Ext:
Department:
Division:
Please list the external parties to the contract (located on
the first page of the contract):
1.
2.
3.
Kindly select one of the following:
AWA - Award Agreement 1 or 2
(Is this an award agreement from a Peer-Reviewed Agency?)
CSA – Agreement for Human Subjects Research1
(Are human subjects involved in the study?)
BSA – Agreement - No Human Subjects
Involved2
(This can include basic or pure science, laboratory, animals, literature
reviews, preclinical etc.)
MTA - Material Transfer Agreement3
(Are you sending or receiving material from/to another party?)
Study Title (as written on the first page of the contract):
Who is funding the study? Please provide us with the name of
the Funder:
Room:
Wing:
REB ID (Research Ethics Board)
#
Pending
N/A
ACC ID (Animal Care Committee)
#
Pending
N/A
PRA - Privacy Agreement4
(aka Data Transfer Agreement - Are you receiving or sending
patient data, samples etc. from/to another party?)
SPA - Service Provider Agreement5
(Are you hiring a service provider to work on a study?)
CDA Confidentiality Agreement
(Are you receiving or disclosing confidential info from/to another
party?)
IP - Intellectual Property Agreement
(e.g., Option Agreement, License Agreement, Assignment
Agreement etc.)
Protocol Number:
Is this an amendment?
Yes 6 No
Type of Funder:
Industry
Who initiated/developed the Study? Please provide us with the name of a
person, institution or company:
Non-Industry
Anticipated Start
Date:
Please provide us with the contact information for the external party to this contract:
Name:
Title:
Phone:
Anticipated
Completion Date:
Email:
For office use only:
Contract Approved by: _________________________________
Date: ________________________
Called for Pick-up by: _________________________________
Date: ________________________
Contract picked up by: __________________________________
Date: ________________________
(Print Name)
Please scan and file a copy of the contract (preferably marked copy) on pick up
1 Please also fill out Addendum #1(Contract Assessment Form): Human Subjects Research
2 Please also fill out Addendum #2 (Contract Assessment Form): Research – No Human Subjects Involved
3 Please also fill out Addendum #3 (Contract Assessment Form): Material Transfer
4 Please also fill out Addendum #4 (Contract Assessment Form): Privacy
5 Please also fill out Addendum #5 (Contract Assessment Form): Service Provider
6
Please fill out Addendum #6 instead of any of the above Addenda
* Please only fill out 1 Addendum per contract
Acknowledgement:
The Addenda are modified from a form used by the Hospital for Sick Children
Revision Date: January 2010