Health Canada Clinical Trial Site Information Form

The Clinical Trial Site Information (CTSI) form is required to be submitted by clinical trial sponsors prior to initiating a protocol or implementing subsequent amendment(s) at the clinical trial site for trials that are subject to Division 5 of Part C of the Food and Drug Regulations or the Clinical Trials for Medical Devices and Drugs Relating to COVID-19 Regulations.

The following information for CHIPER can be entered in the Research Ethics Board Approval section of the CTSI form.

32. Name of Research Ethics Board, including affiliations (if applicable) (full name, no abbreviations): Research Manitoba CHIPER Research Ethics Board

33. Street Number (required): 500

34. Street Name (required): Portage Avenue

35. Suite/Unit: 400

37. City/Town (required): Winnipeg

38. Province/Territory/State (required): Manitoba

39. Country (required): Canada

40. Postal Code/ZIP (required): R3C 3X1

42. First Name (required): Anna

43. Last Name (required): Glybina

44. Email Address (required): CHIPER@researchmb.ca

45. Phone (required): 1-866-248-4375

48. Language (required): English