Add authorized officials in ethics applications Request Form

Application Form to add Authorized Personnel in Ethical Protocols

Please note the following instructions:

For applications of severity level 4-5 or safety issues in which new officials are added, a meeting with a veterinarian MUST be held following their addition to the protocol, (if not yet performed), in accordance with the instructions from the Ethics Coordinator by e-mail. Therefore, THE AUTHORIZED PERSONNEL IN SUCH PROTOCOLS MUST NOT PARTICIPATE IN A RESEARCH BEFORE UNDERGOING AN INSTRUCTION SESSION

Faculty Affiliation *

Ein Kerem / Natural Sciences / Social Sciences / Koret School of Veterinary

Agriculture (except the Koret School of Veterinary)

Details of the PI

Name of the Principal Investigator (The HEAD of the Lab, The Professor) *

Personal authorization number of the Principal Investigator *

E-mail *

Details of Contact Person

Name of Contact Person *

Personal authorization number of Contact Person *

E-mail *

Phone *

Maximum 5 protocols can be asked in this form.

Full Number of requested protocol

For instance: MD-14-12345-3

Animal Facility and Exact unit/s where the research takes place, including name of building

For example: Med School, floor 7 , unit 4

Name\s and valid personal authorization number\s of the requested personnel

Please indicate each authorization number next to the person's name

To be filled out by the ethics coordinator:

Name of Vet / Name of Safety Representative

2. press to add another protocol

Full Number of requested protocol

For instance: MD-14-12345-3

Animal Facility and Exact unit/s where the research takes place, including name of building

For example: Med School, floor 7 , unit 4

Name\s and valid personal authorization number\s of the requested personnel

Please indicate each authorization number next to the person's name

To be filled out by the ethics coordinator:

Name of Vet / Name of Safety Representative

3. press to add another protocol

Full Number of requested protocol

For instance: MD-14-12345-3

Animal Facility and Exact unit/s where the research takes place, including name of building

For example: Med School, floor 7 , unit 4

Name\s and valid personal authorization number\s of the requested personnel

Please indicate each authorization number next to the person's name

To be filled out by the ethics coordinator:

Name of Vet / Name of Safety Representative

4. press to add another protocol

Full Number of requested protocol

For instance: MD-14-12345-3

Animal Facility and Exact unit/s where the research takes place, including name of building

For example: Med School, floor 7 , unit 4

Name\s and valid personal authorization number\s of the requested personnel

Please indicate each authorization number next to the person's name

To be filled out by the ethics coordinator:

Name of Vet / Name of Safety Representative

5. press to add another protocol

Full Number of requested protocol

For instance: MD-14-12345-3

Animal Facility and Exact unit/s where the research takes place, including name of building

For example: Med School, floor 7 , unit 4

Name\s and valid personal authorization number\s of the requested personnel

Please indicate each authorization number next to the person's name

To be filled out by the ethics coordinator:

Name of Vet / Name of Safety Representative

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Application Form to add Authorized Personnel in Ethical Protocols