Instructions for Research Credentialing at Hospitals for Faculty/Employee

For Limited Patient Access or 1B at Norton and/or University Hospital

Credentialing Checklist [XLS], Norton Hospital Credentialing Form [DOC], University Hospital Credentialing Form [DOC]

  1. Government issued photo ID. Must show hospital either your Driver’s License or Passport.
  2. TB test and documentation of Immunizations: contact either your physician or Health Department (574-6514).
    1. Available at the Campus Health Center, 401 E. Chestnut St., Ste. 110 (852-6446) or 2207 South Brook Street (852-6479)
      1. Costs:
        1. MMR Injection (series of 2): $54 + $20 injection fee
        2. MMR Titers: Measles, $11 + $19 drawing fee; Mumps, $22 + $19 drawing fee; Rubella, $6 + $19 drawing fee
        3. Varicella Injection (series of 2): $85 + $20 injection fee
        4. Varicella Titers: $19 + $19 drawing fee
        5. PPD/Tb Skin Test: $24 + $20 injection fee
        6. Tetanus: $43 + $20 injection fee
    2. Also available at the Jefferson Co. Health Dept. at Neighborhood Place, 810 Barrett Ave. (574-6680; appointment required)
      1. Costs:
        1. MMR Injection (series of 2): $51
        2. Varicella Injection (series of 2): $91
        3. Tb Skin Test: $16
        4. Tetanus: $26
  3. Drug screen (ULH requirement): can contact either your physician or Barbara Kemp at OPS at 584-2257.
  4. Security access (IS) must be completed at the respective hospital.
  5. Proof of current liability insurance is available by 2 methods.
  • General liability can be provided by the University if your job responsibilities require this research credentialing/project. Your Department Chair/UBM needs to contact Sandra Russell at 852-4652. She will require documentation of job responsibilities and other information by email.
  • Professional liability insurance is available through some health professional organizations.
  • Documentation of Criminal Background Check (CBC) within last 6 months. The employee/investigator must contact Human Resources, UofL 852-6258, The cost of the CBC is $40 per check. Searches in the state of New York are an additional $55 per check. There will be an additional cost of $10.00 (per name) for searches requesting an alias name. This includes any maiden names, nicknames, and so on. Before requesting the search, confirm with the candidate(s) if they have used the name within the last seven years. HR has a CBC FAQ on their website at:
  • Current CV needs to be signed and dated. Please sign and date each page.
  • Educational Requirements; (Research Integrity will be tracking completions of the training, 1-3 below. The checksheet will not be initialed until the completions are documented in the database.)


    1. Completion of IRB approval of research project is required; therefore, Human Subjects CITI ( and HIPAA ( should have been completed.
    2. Blood borne pathogen training will be required at all the hospitals. The training is available online at: . The educational portion must be completed. Immunization is optional.
    3. If you will be consenting subjects in the hospitals, you must be trained in the consenting process and the documentation in the patient’s chart. Your clinical sponsor will be required to verify that you have the training/expertise to consent human subjects and charting. Thus if you do not already have that expertise we will arrange that training, please call 852-7794 when you are ready for the training. We will require 2 weeks notice.
    4. Hand washing and infectious disease prevention provided by respective hospital.

    Credentialing Form: (Available on the EVPR website.)

    1. All research procedures you will be completing on the Hospital’s premises must be listed under research expertise at the top of the form after your name and University affiliation.
    2. You must circle the correct responses to the certification questions.
    3. The form must be signed by your research supervisor/sponsor. This person must be familiar with your research expertise and must be able to document your competency each year.
    4. Your clinical sponsor must be credentialed at the respective hospital and must be your supervisor at the hospital. In addition, as noted above they must document your competency for consenting of subjects and charting.
    5. The form must be signed by the Service Chief (University Hospital requirement). In some cases this may be the same as the clinical sponsor.
    6. The last person to sign the form must be your Dean. If the Dean is not available (out of town for a period of time); the Executive Vice President for Research (Belknap) or Executive Vice President for Health Affairs (HSC) can sign in their place.

    At HSC all forms will be collected and the checklist components checked by Rita Wedig, PhD, RD, LD K building room 2028 ( or 852-7794) and at Belknap the same will be completed by Allison Ratterman, PhD, (by appointment, 852-2454), LL05 in Jouett Hall.