Grant Number: S06 GM ________________ Project Number_____________________.
Institution:
________________________________________________________________________
1. Descriptive Title: (56 characters or less, including spaces)
________________________________________________________________________
2. Investigator (s)
Last Name: First M.I. Degree Department
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3a. Supplemental Project : Yes:_____ No_____. If yes, award date:______
3b. Are the SNAP procedures followed? Yes:____ No:____. If no, Budget pages submitted: Yes:____ No:____.
4a. Regular Research Project _______ Pilot Research Project _____.
4b. Inventions and Patents Yes:____ No:_____ If “yes”, include details in progress report narrative.
5. Total number of research workers employed on the project: Full time____ Part time_____
6. Protection Against Research Risks:
A. Were human subjects involved in the project? Yes:____ No:_____
If yes, were the procedures approved by your IRB? Yes:____ No:_____
IRB approval termination date:________
B. Were vertebrate animals used? Yes:____ No: ______
If yes, were the procedures approved by your IACUC? Yes:____ No:_____
IACUC approval termination date:_________
C. Are there potential hazards (including biohazards) to laboratory workers (carcinogens, pathogens, ionizing radiation, etc.) engaged in the research?
Yes:_____ No: ______
If yes, was training in biohazards conducted? Yes:____ No:_____