Download Forms


Have you tried WIRB's online "smart form" submission process? It will help answer questions you might have about your submission. Smart forms are available for initial review, change in research, and study closure. Do not download your form from below, instead log on to WIRB ConnexusTM (https://connexus.wirb.com) to establish an account and get started!

The forms below provide WIRB's Board with all required IRB review documentation at the point of submission. Please provide a submission form with each protocol you submit for review. For questions or assistance, please reference the FAQ (frequently asked questions), call (800) 562-4789, or send e-mail to clientservices@wirb.com for assistance.
New Studies
Name Version Date Fillable Word Adobe PDF
WIRB Investigator Handbook "A Guide for Researchers" 07/29/2014 PDF
Investigator Guidance (Sample SOPs) 02/20/2014 PDF
Initial Review submission Form 07/2012r3 Word
Additional Sites Page (Initial Review) 07/2012r1 Word
Annotated Initial Review Submission Form 07/2012 PDF
Investigator Submission Form for Multi-Center Protocols 07/2012r2 Word
Initial Review Submission Form for Sponsors and CROs 07/2012r3 Word
Initial Review Submission Form for International Sites 07/2012r1 Word
HUD On-Label Use Submission Form 02/06/2013r1 Word
Request for Exemption Determination 12/23/2013r2 Word
Request for Exemption Determination - Canada 04/23/2013r1 Word
New Jersey Requirements for Inclusion of Decisionally Impaired Subjects (New Jersey Statute 26:14-5) 05/14/2012 Word
Request for a Partial Waiver of Authorization for Recruitment (HIPAA Partial Waiver of Authorization) 02/20/2014 Word
Request for Full Waiver of Authorization under HIPAA 02/20/2014 Word
IRB Transfer Cover Letter Checklist & Summary Form 11/18/2010 Word
Waiver of Consent Request for In Vitro Diagnostic Device Studies Using Leftover Human Specimens That Are Not Individually Identifiable 09/28/2006r1 Word
Sample IRB Authorization Agreement (with WIRB filled in as institution A) 03/31/2011 Word
Initial Review Submission Form Addendum for Department of Defense Funded Research 11/25/2013 Word
Locations With Obligations to other IRBs - Dual Oversight - US Site 07/03/2012 Word
Locations With Obligations to other IRBs - Dual Oversight - Canadian Site 07/03/2012 Word
Locations With Obligations to other IRBs - Split Oversight 07/03/2012 Word
Locations With Obligations to other IRBs - Waive Oversight to WIRB 07/03/2012 Word
WIRB Consent Form Template 06/13/2014 Word
Pregnant Partner Template Consent Form 06/13/2014 Word
Template Information Sheet for Waiver of Documentation of Consent 07/24/2014 Word

Studies in Progress
Name Version Date Fillable Word Adobe PDF
Change in Research and Subject Recruitment Submission Form 04/08/2014r1 Word
Change in Research Additional Sites Page 01/12/2012r1 Word
Translation Request Submission Form 07/29/2013r1 Word
Screening Procedures Information Form 10/01/2009 Word
Financial Interest Disclosure Form 10/01/2009 Word
Promptly Reportable Information Form 10/08/2013r1 Word
Unanticipated Problems Reporting Form - Adverse Events (retired 02-14-2014, see Promptly Reportable Information Form replacement) 02/14/2014 Word
Unanticipated Problems Reporting Form - Problems that are Not Adverse Events (retired 02-14-2014, see Promptly Reportable Information Form replacement) 02/14/2014 Word
Non-Site Adverse Event Report Submission Form (retired 02-25-2014, see Promptly Reportable Information Form replacement) 07/17/2013 Word
Recruitment Bonus Disclosure Form 10/01/2009 Word
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
Instructions for Notifying Subjects of WIRB's Move to Puyallup, Washington (Letter to subjects also available in Polish, Russian, Simplified Chinese, Spanish, Korean, Japanese, French, Armenian, Traditional Chinese and Vietnamese) 11/19/2013 Word
Emergency Use Post-Use Report Form 11/13/2013 Word
Contact Information Update Form 10/31/2013r1 Word

Continuing and Final Review
Name Version Date Fillable Word Adobe PDF
Study Closure Report Form 02/04/2014 Word
Continuing Review Report Form (CRRF) Work Sheet 12/2008 PDF
Continuing Review Report Form (CRRF) Instructions for Sites Using Humanitarian Use Devices (HUDs) 10/12/2010 PDF


Translated Short Forms for Consent 

(View an English version of this OHRP short form here: http://www.hhs.gov/ohrp/policy/ic-non-e.html#sample)

Name Version Date Word Adobe PDF
Arabic Short Form (Translation certification) 02/12/2014 Word
Armenian Short Form (Translation certification) 04/29/2013 Word
Creole Short Form (Translation certification) 07/24/2014 Word
French Short Form (Translation certification) 04/29/2013 Word
Gujarati Short Form (Translation certification) 02/12/2014 Word
Japanese Short Form (Translation certification) 04/29/2013 Word
Korean Short Form (Translation certification) 04/29/2013 Word
Russian Short Form (Translation certification) 04/29/2013 Word
Simplified Chinese Short Form (Translation certification) 04/29/2013 Word
Spanish Short Form (Translation certification) 04/29/2013 Word
Traditional Chinese Short Form (Translation certification) 04/29/2013 Word
Vietnamese Short Form (Translation certification) 04/29/2013 Word
 
Sending the forms to WIRB
Please complete and return your form(s) to WIRB via WIRB ConnexusTM (https://connexus.wirb.com), e-mail, fax, or postal mail.

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