STUDY VISIT CHECKLIST ENSURE CONSISTENCY AND DOCUMENTATION OF STUDY

  INTERNATIONAL PILOT STUDY ON THE EVALUATION OF
  RESILIENCE IN THE FOOD CHAIN A STUDY
STUDY NAME OPTIONS ANALYSIS PREPARED BY NAME TITLE JOB

14 8BXXXE INTERNATIONAL TELECOMMUNICATION UNION RADIOCOMMUNICATION STUDY
14 CUSTOMS COOPERATION CASE STUDY FOR CANADA
283 FUENTE WWWITUINTITUDSTUDYGROUPS SGP20022006SG2133000S4DOC RESULTADO SUPLEMENTARIO

SUBJECT VISIT CHECKLIST:





STUDY VISIT CHECKLIST

Ensure consistency and documentation of study visits.


Principal Investigator: ____________________ IRB#: ______________________ Sponsor: _________________________


Study Title: _______________________________________________________________________________________________















SUBJECT ID: DOB:


INFORMED CONSENT





PI/Authorized Staff Explained Study

PI/Staff:


Copy of consent given to adult subject and/or LAR; child subject and/or Parent or Legal Guardian

Adult Subject and/or LAR; Child Subject and/or Parent or Legal Guardian- Signed Consent

Date Signed:


Is Consent Valid?

YES NO

If subject did not sign consent, explain:







STUDY VISITS





**Please customize this form to meet the visit requirements of your specific study.

Study Visit 1:

Date Completed:

PI/Staff Initials

If subject did not complete test or completed test on different date, please explain:

e.g. Complete Blood Count




e.g. Pulmonary Function Test




e.g. EKG




e.g. Chest x-ray
























Study Visit 2:

Date Completed:

PI/Staff Initials

If subject did not complete test or completed test on different date, please explain:



































Study Completion:



If subject did not complete study, please explain:

Subject Completed Study

Date Completed:



If applicable, study reimbursement

Date Given:












NOTES:











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3 RADIOCOMMUNICATION STUDY GROUPS SOURCE DOCUMENT 4CTEMP42(REV1)
6 7BL13E INTERNATIONAL TELECOMMUNICATION UNION RADIOCOMMUNICATION STUDY
9 7D129 (ANNEX 3)E RADIOCOMMUNICATION STUDY GROUPS


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