WESTAT PROTECTION OF HUMAN SUBJECTS TRAINING

CERTIFICATION OF COMPLETION

Please fill out form electronically

Employee’s Information

Employee’s Name:

LAST	FIRST	MI

Westat ID Number:	Study Area Organization Number:

I have completed Westat’s instruction on the Protection of Human Subjects. The version was:

Systems and Data Management Staff

Project Staff

Signature:	Date Completed:

MM/DD/YYYY

For Computer Systems Staff (except those in the Clinical Trials Area):

E-mail the form as an attachment, or send a signed hard-copy of this form to
Cecilia Wilson at WB316S. If the form is sent as an e-mail document, a signature is not required.

For All Other Staff:

E-mail the form as an attachment, or send a signed hard-copy of this form to Carol Dollarhide at WB315. If the form is sent as an e-mail document, a signature is not required.

Revised: 07/06/2007

ATTACHMENT G

varela_j

2006-02-07

Cecilia Wilson