Northern Sydney Local Health District Research Office
Notification of Changes in Research Personnel
Submission instructions
  1. Do not submit a cover letter with this form
  2. This form should be filled in electronically, printed, and signed by the Principal/Coordinating Investigator and any new investigators. Electronic signatures are not accepted by the Office.
  3. Changes to the Co-ordinating Investigator or Principal Investigator at a site are to be notified to the HREC as well as the relevant site Research Governance Officer (RGO).
  4. If this change is for an associate investigator or site contact person, only the relevant site RGO needs to be notified
  5. Please submit one hard copy of this form and email to the Research Office:
Mailing address
Research Office
Level 13, Kolling Building
Royal North Shore Hospital
St Leonards NSW 2065 / In person
Kolling Building level 4 (ground floor lobby) – dial x64590 and a member of the Research Office team will come to collect your submission
Email the complete form to
Subject: “Change in Personnel – Short title – NSLHD Reference”
SECTION 1 – PROJECT DETAILS
NSLHD file number xxxx-xxxM or RESP/14/xx
HREC number eg. HREC/xx/HAWKE/xxx or HARBR
Project Title
Coordinating Investigator
(for single-site studies this is synonymous with Principal Investigator)
Is the Coordinating Investigator changing?
If yes, this form should be submitted to the HREC and, following approval, forwarded to all sites / Yes / No
Is the Principal Investigator at a site changing?
If yes, this form should be submitted to the HREC and, following approval, forwarded to the relevant site RGO / Yes / No
SECTION 2 – DELETE PERSONNEL
YESInvestigator details:
Date ceased working on study: DATE / NO continue to section 3
SECTION 3 – ADD PERSONNEL YESNO continue to section 5
Name:
Role in project:
Research responsibilities:
Name of study site:
Professional e-mail:
Are you currently employed by the site? Yes No (external researchers are required to provide additional supporting documents
Contact address:
Contact number:
Proposed commencement date:
Short CV submitted with this form:Yes No if no why not?
SECTION 4 – NEW PERSONNEL DECLARATION
I declare I have read the study protocol & understand my obligations and responsibilities regarding the conduct of the study
Signature:
Date:
SECTION 5 – PRINCIPAL INVESTIGATOR DECLARATION
The Principal Investigator at the site where the personnel change has occurred completes this section. However, if the change relates to the Principal Investigator at a site then the Co-ordinating Investigator must sign this section.
I confirm that the new study personnel named on this form are appropriately qualified and trained in administration of the approved study protocol.
Name:
Signature:
Date:
Contact details for return correspondence:
Name:
Email: phone:
NSLHD RESEARCH OFFICE USE ONLY
HREC Exec ReviewN/A Not change in PI/CI
Date:
Action:
Name:
Signature:
Designation:
NSLHD Research Governance Officer ReviewN/A Please forward this form to relevant site RGO
Date:
Action:
Name:
Signature:
Designation:

NSLHD Research Office – Change in Personnel – Form updated April2016RESD/14/2866

Always download this form from the Research Office website to ensure you are using the most recent version 1