Forms
IACUC Forms
It is the responsibility of the PI and his/her support staff to complete (type) protocol submission forms. Please make sure to check the IACUC website for the most recent version of the needed form before beginning a submission. Submissions received on outdated forms will be returned to the PI without review.
Please send completed protocol submissions to IACUC, PO Box 6223, Mississippi State, MS 39762 or Mailstop 9563 or hand deliver to the IACUC Office at 1207 Hwy. 182 West. All late submissions (those arriving after the stated deadlines) must be approved by Brian Rude, IACUC chair, for inclusion on the agenda for an IACUC meeting.
IACUC Protocol Review Form · Version 12/2008 pdf | doc
Instructions for completion of the Protocol Review Form.
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Protocol Annual Update/Amendment Form
Instructions for completion of the Annual Update Form.
Occupational Health & Safety Program
IACUC Developmental Approval Form - Version 08/2009 (pdf)
Instructions for completion of the Developmental Approval Form
Biosafety Forms
IBC Application Form
Exposure Control Plan
IBC Modification Form
Animal Biosafety Level 2 Inspection Form
Biosafety Level 2 Laboratory Certification and Annual Inspection
Research Biosafety Review
BSL -2 Lab SOP Template
Emergency and Incident Plan Template
BSL-2 Lab Biosafety Manual Template
Lab Exit Checklist
Incident Report Template
Equipment Decon Tag
Hazardous Waste Pickup Requests
There are currently two ways to request a hazardous waste pickup. In preferred order...
- Submit a completed internet request form.
- Telephone a pickup request at 5-3294
Application to become an authorized radioactive materials user
Faculty or staff members must complete an application in order to become an authorized radioactive materials user. Your application must be approved by the Radiological, Chemical, and Laboratory Safety Committee before you can obtain or use radioactive materials. Contact the Radiological Safety Officer if you need assistance in completing the application.
Your completed application should be returned to the Regulatory Compliance Office. (Both links open a new page.)
IRB Application Forms
Please review the IRB Investigator's Manual before submitting an application.
IRB General Application Form
Updated October 2004
Oral History IRB Application
This form is to be used when doing an oral history project. See below for specific template consent language.
Existing Data/Secondary Data IRB Application
This form is intended for use only when using individual level data.
Consent & Assent Templates
Informed Consent Template
Version 10/09
Oral History Informed Consent Template
Assent Templates
For use when minors are subjects of the research.
Modification Templates
These forms should be used for modification of current projects. This form may not be used for time extensions.
Other Forms
Continuing Review Report Form
Requests for continuing review must be received by the IRB 30 days prior to the expiration date in order to ensure there is no lapse in approval. If there is a lapse in IRB approval, all research must halt per Federal Regulations and MSU Policy until continuing IRB approval is secured.
Investigator Assurance of Identifier Removal
This form is only needed if you wish to terminate IRB approval prior to the end of data analysis.
Closing Report
Individual Investigator Agreement
Using Cash Incentives: Procedure and Payment Form
Vulnerable Populations Supplemental Forms
This form must be submitted upon the occurrence of a problem that is (1) unexpected (in terms of nature, severity, or frequency), and (2) related or possibly related to the research. The Problem Report must be submitted as soon as possible, but always within 10 days of the event. Serious problems must be reported to the IRB verbally within one business day, in addition to the submission of the written Problem Report.