::: : Institution Ethics Committee
INSTITUTIONAL ETHICAL COMMITTEE
 
The Institutional Ethical Committee formed by the following  Members:
 
  1. Dr. P. Ravi sankar, MD.,(F.M.) D.H.A., - Dean – Chairman
  2. Dr. R. Muthulakshmi, MD., (Phy) DGO., - Vice principal – Co Chairman
  3. Dr. E. Sivakumar, M.S., D.L.O., FRCIS., Dip. N.B., - Dy., Med. Sup.,
  4. Dr. K. Jayakumar, MS., Gen. Surg.,        
  5. Dr. GO. Bharani, MD., Gen. Medi.,
  6. Dr. K. Thirumal Babu, MD., DM., - Member Secretary
  7. Dr. Radha saraswathi, Scientist,
  8. Mr. Sivaraj, MA BL – Lawyer
  9. Mr. Suresh Jain – Social Worker.
GOVT. VELLORE MEDICAL COLLEGE, VELLORE – 11.
INITIAL REVIEW SUBMISSION FORM FOR ETHICAL CLEARANCE.
 
 
S.No Submission Date Approved / Not Approved. Date Resubmission Date
 
Approved Date
 
 
       
 
 
S.No Title Particulars.
1 Title of the research proposal  
2 Name of the Principal Investigator (PI)with Qualification and Designation  
 
3 Name of the Co-Investigator(s)Co-PI)with Qualification and Designation  
 
4 Source of funding & Financial allocation for the project / trial  
 
5 Name of the Departments where research is to be conducted.  
6 Duration of the Project / trial  
7 No of Patients involved  
8 Type of study ( Placebo / Double blind etc.,)  
9 Any other institution collaboration is needed / International collaboration / Any other ethical committee approval needed  
10 Research Proposal: Main objectives.  
11 Whether genetic / Drugs / Radiation / Invasive procedure involved.  
 
12 Research Proposal: Relevant background information.  
 
13 Usefulness of the project / trial.  
14 Expected “benefits” to volunteer / community.  
15 Explain all anticipated ‘risks’ (adverse events, injury, discomfort…) of the project.  
 
16 Efforts taken to minimize the ‘risks’  
 
17 Explain the plans to maintain confidentiality of records / Data.  
18 Whether ‘wage compensation’ for the research subjects be provide?  
 
19 Research Subject Information form. / Consent form.  
20 Methodology/ Study design  
21 Inclusion criteria  
22 Exclusion criteria  
23 Any other details regarding the study  
24 Describe the Informed Consent Process.  
25 Disclose Conflict of Interest, if any.  
26 Signature of the Principal Investigator with date.  
 
27 Specific ethical issues, as identified by the investigating team.   ( Office use )  
 

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