Research Needs Assessment Tool

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Required format:

DJk9d6V4ZCRHsMEqvwxbtyUHhQVpeTFRr

The Center for Clinical and Translational Research (CCTR) and the Research Incubator (RI) are providing this easy-to-use Research Needs Assessment Tool to help you expedite the launch of your research project. This tool will help guide you through a series of questions, specific to your project, using an intuitive step-by-step process. Upon completion of this Research Needs Assessment Tool you should have a better understanding of what is required of you and your staff as you initiate your project.

Depending on your needs this Research Needs Assessment Tool should take approximately 10 to 20 minutes to complete. If you wish, you may Save and Return Later rather than completing the Research Needs Assessment Tool in one session (a user-specfic validation code will be provided) . Once completed and submitted, the data will be made available to the CCTR Research Incubator liaison who will then have the requisite information necessary to effectively assist you with your research project.

NOTE: Prior to SUBMITTING, you may wish to print-out a copy of the completed form for your records. Thank you.

Please provide your LAST NAME:

* must provide value

Please provide your FIRST NAME:

* must provide value

Email Address:

* must provide value

Your phone number:

* must provide value

Will DRUG(S) be administered in this project?

* must provide value

Yes

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Drug Name(s):

Are you evaluating MARKETED MEDICAL DEVICE(S) (including 510k devices) in this project?

* must provide value

Yes

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DEVICE NAME(S):

NAME OF MANUFACTURER:

Does this project involve the use of any procedure(s) that will expose the research subject to IONIZING RADIATION?

* must provide value

Yes

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If all of these procedures are for the direct clinical benefit of the research subject/patient, check YES. If any of these procedures are of research interest only and will not affect the clinical management of the research subject, check NO.

Yes

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RADIATION SAFETY COMMITTEE (RSC) approval is required since you answered NO to the above question. Do you have RSC approval for this project?

Yes

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Does this project involve the use of RECOMBINANT DNA, BIO-HAZARDOUS SUBSTANCES including pathogenic or potentially pathogenic viruses and bacteria (e.g., Adenovirus, HIV, Hepatitis B), CARCINOGENS OR ACUTE CARCINOGENS, MUTAGENS, TERATOGENS, ACUTE TOXINS, OR SELECT AGENT MATERIALS?

* must provide value

Yes

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INSTITUTIONAL BIOSAFETY COMMITTEE (IBC) approval is required because you answered YES to the above question. Do you have IBC approval for this project?

Yes

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Does this study involve cancer patients, their families, or their health care providers?

* must provide value

Yes

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Is this a Cancer Prevention Study?

* must provide value

Yes

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Will this project be conducted in the GENERAL CLINICAL RESEARCH CENTER (GCRC)?

Yes

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Will the VCU/VCUHS INVESTIGATIONAL DRUG PHARMACY be utilized (required for all in-patient projects)?

* must provide value

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.