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Center for Clinical and Translational Science (CCTS)
Research Resources
Reporting Complaints and Concerns
Research Involving Human Subjects Form
Research Involving Human Subjects Form
A. Your Name
Name (Optional or Initials Only):
May we reveal that you are the source of this concern or complaint to the study’s Principal Investigator and other study staff?
Yes
No
B. Personal Contact Information (REQUIRED if you wish to hear back from us regarding this complaint)
Phone:
Email Address:
Alternate Phone:
Other Contact Info
Unless you authorize us to do so, your personal contact information will not be released to anyone outside the HRPP.
Are you making this report for someone else?
Yes
No
If Yes please explain:
C. Study Information
1. Please tell us about the study for which you have a concern or complaint:
Study Name or Description:
Name of Study Investigator(s):
Study Phone Number:
2. Please tell us about the research concern or complaint you are reporting:
3. Please tell us how would like to see your concern or complaint resolved:
4. Have you discussed this concern or complaint with the Principal Investigator or other study staff?
Yes
No
If yes, please let us know who you contacted:
5. Are you or were you a participant in this study?
Yes
No
If yes, please answer questions a to d below:
a. When did you start participating in the study? (Please guess even if you can’t remember):
Date:
b. Are you still participating in the study?
Yes
No
c. Do you have a consent form for this study?
Yes
No
If yes, please email a copy of the consent form.
d. Do you have any other written information about this study?
Yes
No
If yes, please email any other written info.
If you are unable to email, please wait for a staff member to contact you before providing these documents.
If you have additional comments or need additional space, please email additional sheets.
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COVID-19 Related Guidance to Researchers
About
About
PI and Director
Leadership Team
Advisory Committees
Contact Us
News
News
CCTS News Highlights
Newsletters
News Archives
News Archives
2019 News Archives
2018 News Archives
2017 News Archives
2016 News Archives
2015 News Archives
Funding
Funding
Medical Device Innovations Program
UMass Life Sciences Moment Fund (LSMF)
Pilot Project Program (PPP)
Small Conference Grants
SPARK Program
Voyager Therapeutics PPP
Research Resources
Research Resources
Regulatory Reviews
Regulatory Reviews
IRB
Ancillary Reviews
Conflict of Interest
Office of Clinical Research (OCR)
Core Resources
Core Resources
Bioinformatics
Biorepository & Tissue Bank
Biostatistics, Epidemiology, and Research Design (BERD)
Informatics
Community Engagement
Community Statistics
Clinical Research Center
Investigational Drug Service
Small Molecule Screening
Science Participation Research Center (SPRC)
Research Cores (others)
Umbilical Cord Blood Facility
Institutional Centers
Institutional Centers
Commonwealth Medicine
Massachusetts Medical Device Development Program (M2D2)
MassBiologics
Meyers Primary Care Institute
Protocol Development
Protocol Review Committee (PRC)
Reporting Complaints and Concerns
Reporting Complaints and Concerns
Research Involving Human Subjects Form
ClinicalTrials.gov Resources
Interpreter Services for Clinical Research
Recruitment Resources
Quality Assurance/Quality Improvement
Rigor
Request Services (TRAcs)
Find a Study
Education and Training
Education and Training
I-Corps Program at the UMCCTS
"K-Club"
KL2 Training Program
TL1 Training Program
TL1 Training Program
T-Training Program Q&A
Human Research Protection Progam (HRPP)
Community Engagement
Community Engagement
CE Home
About Us
Symposia
Symposia
Symposium 2020
Symposium 2020
2020 Keynote Speaker
2020 Speaker Biographies
2020 Presentation Descriptions
Symposia Archives
Programs and Resources
Programs and Resources
Participate in Research
Participate in Research
All of Us
Conquering Diseases
MA CTSA Webinar Series
MA CTSA Webinar Series
COVID-19 Webinar Series
Public Engagement Project
Community Engagement Studios
Community Statistics
Creating Research Teams
Creating Research Teams
Resources for Community Engaged Research
Pilot Projects
CRISP Scholars
CRISP Scholars
Past CRISP Scholars
Developing a Poster
NIH Research Mentor Guidelines
CIRTification
Contact Us
Contact Us
Request a Consultation
Join Our Email Community Forum
Request a Studio
CCTS Home
Additional Resources