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Pdf-based smart forms are available below for sending initial reviews, changes in research, promptly reportable information, and study closure information.

Please note the following about our smart forms:

  • The smart forms must be completed using either Adobe's free Reader or Adobe Acrobat (version 11 or newer). Use of a program other than Adobe (version 11 or newer) to view or complete the forms will result in missing questions and non-functional fields.  To download Adobe Reader for free, please visit https://get.adobe.com/reader/.   
  • Because these smart forms are dynamic (change based on your responses), they must be completed electronically; therefore, you cannot print them out and complete them on paper. However, at any time during their completion, you can edit, save, print, or share with your colleagues.
  • The forms have been adopted by WIRB, NEIRB, MLIRB, Aspire, and CGIRB.

 

The forms below provide WIRB with all the required IRB review information required.  Please provide a submission form with each protocol you submit for review. 

For questions or assistance, please see the WIRB Guide for Researchers available below, call 1-800-562- 4789, or email clientservices@wirb.com.



New Studies
Name

Version Number
Release Date

 Fillable
 Word		 Adobe PDF

WIRB Investigator Handbook "A Guide for Researchers"

  • Canadian guidelines supplement click here
 4.40
09/03/2019

PDF

 
Investigator Guidance (Sample SOPs) Moved to Miscellaneous Resources Tab

Initial Review submission Form (HRP-212)

(Note: this version will expie March 1, 2020; new version will be posted here. Please plan to download the new version when that date approaches. If you have a recently expired version, and need to edit it, we can assist you.)

4.0.2.23
10/03/2019

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

Clinical Use of a Humanitarian Use Device Submission Form (HRP-284)

1.1.1
09/19/2018

PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

Financial Interest Disclosure Form (HRP-216)

1.1.0
01/02/2019
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form
Initial Review Submission Form for International Sites - RETIRED, Use Initial Review Submission Form above  
Canadian Supplement (HRP-213)

1.1.2
09/13/2019
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form
Request for Exemption Determination - RETIRED
Use Initial Review Submission Form above
Request for Exemption Determination - Canada RETIRED
Use Initial Review Submission Form above
Single Patient Expanded Access Submission Form - RETIRED
Use appropriate form HRP-280, HRP-281, HRP-282 or HRP- 283 below instead. 		For more info, see the Expanded Access tab
Approval in Principle Request Form 04/10/2018 Word
New Jersey Requirements for Inclusion of Decisionally Impaired Subjects (New Jersey Statute 26:14-5) 05/14/2012r1 Word
IRB Transfer Cover Letter Checklist & Summary Form 09/19/2016 Word
Sample IRB Authorization Agreement (with WIRB filled in as institution A) 03/31/2011 Word
Addendum for Department of Defense Funded Research 05/04/2018 Word
Reliance Agreement 1 (formerly titled "Locations With Obligations to other IRBs - Dual Oversight - US Site") 07/07/2017 Word
Reliance Agreement 2 (formerly titled "Locations With Obligations to other IRBs - Dual Oversight - Canadian Site) 07/07/2017 Word
Reliance Agreement 3 (formerly titled "Locations With Obligations to other IRBs - Split Oversight") 07/07/2017 Word
Reliance Agreement 4 (formerly titled "Locations With Obligations to other IRBs - Split Oversight - Canadian Site") 07/07/2017 Word
Reliance Agreement 5 (formerly titled "Locations With Obligations to other IRBs - Waive Oversight to WIRB") 07/07/2017 Word

Request for a Partial Waiver of Authorization for Recruitment (HIPAA Partial Waiver of Authorization)

Note: this form is incorporated in the Initial Review Submission Form and Change in Research form, so use this stand-alone form ONLY if you are NOT using those forms for your request.

 07/31/2019 Word

Request for Full Waiver of Authorization under HIPAA 

Note: this form is incorporated in the Initial Review Submission Form and Change in Research form, so use this stand-alone form ONLY if you are NOT using those forms for your request.  
 12/15/2015 Word
WIRB Consent Form Template 05/14/2019 Word
Pregnant Partner Template Consent Form (pregnant partner information release form ) 09/08/2019 Word
Pregnant partner information release form signature page addendum – for pregnant partners who require a legally authorized representative 06/17/2016 Word
Template Informed Consent for Emergency and Compassionate Use (HRP-502) 10/09/2019 Word
Translation Request Submission Form (HRP-230)

4.1.0.22
01/29/2019

PDF

Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

FORM: Emergency Use of a Drug or Biologic (HRP-280)

 

 

1.2.0.22
03/22/2019

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

FORM: Emergency Use of a Device (HRP-281)
 

 

1.2.0.22
03/22/2019

 

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

FORM: Compassionate Use of a Drug or Biologic (HRP-282)
 

 

1.2.0.22
03/22/2019

 

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

FORM: Compassionate Use of a Device (HRP-283)
 

 

1.2.0.22
03/22/2019

 

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form


Studies in Progress
Name Version Number
Release Date		 Fillable
Word		 Adobe PDF
Change in Research Submission Form
3.0.1.23
10/03/2019

Smart PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, and open the destination folder to open the form 

Promptly Reportable Information Form
3.0.1.23
10/03/2019
  

Smart PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, and open the destination folder to open the form 

Recruitment Bonus Disclosure Form (HRP-217)
1.1.0.22
03/22/2019
PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, and open the destination folder to open the form 
Impartial Witness Form for Limited and Non-Readers 02/10/2013 Word
Consent addendum for subjects originally enrolled as children who are now adults 01/19/2011 Word
California Experimental Subjects' Bill of Rights 03/22/2017 Word
Contact Information Update Form 04/30/2018 Word

Continuing and Final Review
Name Version Number
Release Date		 Fillable Word Adobe PDF
Site Continuing Review Form
 


Sent via email by the IRB to designated contacts. Also available on the site workspace in Connexus.  

Protocol Continuing Review Form
 


Sent via email by the IRB to designated contacts. Also available on the study workspace in Connexus.  

Site Closure Report Form (HRP-252)
3.0.2.23
10/03/2019

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, & open the destination folder to open the form 

HUD Clinical Use Closure Form (HRP-253)
1.0.1
06/27/2019

PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, and open the destination folder to open the form 


Translated Short Forms for Consent based on the WCG Template Short Form - compliant with the 2018 Common Rule elements of consent: (Click here for the WCG template short form.) 

<><><>
Name Version Date Word Adobe PDF
Amharic Short Form (2018 Common Rule) (Translation certification) 10/03/2019 Word
Arabic Short Form (2018 Common Rule) (Translation certification) 02/11/2019 Word
Armenian Short Form (2018 Common Rule) (Translation certification) 03/06/2019 Word
Burmese Short Form (2018 Common Rule) (Translation certification) 05/23/2019 Word
Cambodian Short Form (2018 Common Rule) (Translation certification) 06/06/2019 Word
Chinese (simplified) Short Form (2018 Common Rule) (Translation certification) 02/11/2019 Word
Chinese (traditional) Short Form (2018 Common Rule) (Translation certification) 02/11/2019 Word
Farsi Short Form (2018 Common Rule) (Translation certification) 03/06/2019 Word
Gujarati Short Form (2018 Common Rule) (Translation certification) 07/11/2019 Word
Haitian Creole Short Form (2018 Common Rule) (Translation certification) 03/29/2019 Word
Hebrew Short Form (2018 Common Rule) (Translation certification) 06/21/2019 Word
Hindi Short Form (2018 Common Rule) (Translation certification) 04/12/2019 Word
Hmong Short Form (2018 Common Rule) (Translation certification) 06/10/2019 Word
Italian Short Form (2018 Common Rule) (Translation certification) 04/22/2019 Word
Japanese Short Form (2018 Common Rule) (Translation certification) 02/11/2019 Word
Korean Short Form (2018 Common Rule) (Translation certification) 02/11/2019 Word
Polish Short Form (2018 Common Rule) (Translation certification) 02/11/2019 Word
Portuguese - Brazilian Short Form (2018 Common Rule) (Translation certification) 10/03/2019 Word
Portuguese - European Short Form (2018 Common Rule) (Translation certification) 10/03/2019 Word
Punjabi Short Form (2018 Common Rule) (Translation certification) 04/09/2019 Word
Russian Short Form (2018 Common Rule) (Translation certification) 02/13/2019 Word
Spanish Short Form (2018 Common Rule) (Translation certification) 01/18/2019 Word
Tagalog Short Form (2018 Common Rule) (Translation certification) 10/03/2019 Word
Vietnamese Short Form (2018 Common Rule) (Translation certification) 01/31/2019 Word

Translations of the California Experimental Subject's Bill of Rights <><><> 
Name Version Date Word Adobe PDF
Armenian California Experimental Subject's Bill of Rights (Translation certification) 08/03/2018 Word
Chinese (Simplified Chinese) California Experimental Subject's Bill of Rights (Translation certification) 04/27/2017 Word
Farsi California Experimental Subject's Bill of Rights (Translation certification) 04/27/2017 Word
French (Parisian) California Experimental Subject's Bill of Rights (Translation certification) 04/27/2017 Word
Japanese California Experimental Subject's Bill of Rights (Translation certification) 09/13/2017 Word
Korean California Experimental Subject's Bill of Rights (Translation certification) 09/13/2017 Word
Russian California Experimental Subject's Bill of Rights (Translation certification) 09/18/2017 Word
Spanish California Experimental Subject's Bill of Rights (Translation certification) 04/11/2017 Word
Tagalog California Experimental Subject's Bill of Rights (Translation certification) 04/11/2017 Word
Traditional Chinese California Experimental Subject's Bill of Rights (Translation certification) 04/26/2019Word
Vietnamese California Experimental Subject's Bill of Rights (Translation certification) 08/03/2018 Word
 
Sending the forms to WIRB
Please complete and return your form(s) to WIRB via Connexus® or IRBNet. Documents submitted via email, fax or postal mail may be charged an additional processing fee.

WIRB
1019 39th Avenue SE Suite 120
Puyallup, Washington 98374-2115
USA
E- mail: clientservices@wirb.com
Fax: (360) 252-2498