Institutional Review Board

IRB Forms - Electronic Submission through CyberIRB

CyberIRB

Aspirus Wausau Hospital utilizes the internet to submit applications to the IRB through the use of a new program, "CyberIRB."   This program is accessible from any computer at any site.

If you are a new Investigator or an investigator who has previously submitted a paper IRB submission form please contact the IRB Office at 715.847.2569 to receive instructions, a USER ID and Password to access CyberIRB.

Application Forms

The application forms below will be located in CyberIRB to be completed and submitted to the IRB electronically. 

For IRB meeting dates and submission deadlines please refer to the IRB meeting dates on this website.  If you have any questions or need assistance please contact the IRB/Human Research Protections Coordinator.

  1. Full Board or Expedited Application for Initial review 10-09.doc – Use this form when submitting a new research project for expedited review.
  2. Exemption Request Form 3-08.doc – Use this form when submitting a project that may qualify for exempt review status.
  3. Informed Consent Template (signed) 3-10.doc  - This is an example of the IRB approved format for consent forms, including all required elements of informed consents as well as IRB suggested language. 
  4. Informed Consent Statement template (unsigned).doc - This is an example of the IRB approved format for a research consent statement used for surveys, or phone interviews that includes all the required elements of an informed consent but is not signed. 
  5. Waiver_of_Informed_Consent_Request_3-08.doc - Use this form when requesting waiver of an informed consent for a clinical study protocol.
  6. Waiver_of_Use_Disclosure_of_Informed Consent Form_3-08.doc
  7. Emergency Use Report Form_3-08.doc - Use this form when reporting the use of a test article in a life-threatening situation.
  8. Humanitarian Use Device (HUD) Request_form_3-08.doc  - Use this form when submitting a request to utilize a Humanitarian Use Device.
  9. Modification_Request Form_10-09.doc - Use this form when submitting any change to the protocol such as amendments, revisions, consent form changes, enrollment closures any other miscellaneous changes.  Also use for submitting Data Safety Monitoring Committee reports, new findings, correspondence from sponsors, and study results. 
  10. Adverse Event Report Form111709.doc - Use this form when submitting all Local adverse events or Off-Site Unanticipated/Unexpected and Related adverse events.
  11. Continuing Review (full or expedited) /Final Closure 10-09.doc - Use this form when submitting a progress report for clinical studies or when requesting final closure/termination of IRB oversight. 
  12. Humanitarian Use Device (HUD) Continuing Review/Final Closure Report 10-08.doc - Use this for when submitting a yearly progress report or closure of a HUD.
  13. Deviation Form 04-11.doc  - Use this form when notifying the IRB of a protocol deviation.