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CTO Stream: How It Works

What is it?

Working with REBs and institutions across the province, CTO has built a system that allows one Research Ethics Board (REB) to oversee the ethical conduct of research occurring at multiple sites in Ontario. All reviews are conducted by a CTO Qualified REB, ensuring the highest ethical standards are maintained.

What does this mean?

  • If you have a multi-site study, the ethics review will be done by one CTO Qualified REB.
  • Sites will use the same ethics application forms and standardized consent form templates.
  • Getting ethics approval for additional sites is quicker and more efficient.

How does it work?

One research team will submit the provincial, study-wide application on behalf of all sites in Ontario through CTO Stream (web-based ethics application). Once the Provincial application is approved by the designated REB (the REB of Record), sites submit their Centre application to obtain ethics approval to join the study.

Key Points:

  • These abbreviated Centre applications are submitted through CTO Stream and reviewed by the same REB which approved the study provincially.
  • Sites use the provincially approved consent templates to create their site-specific consent forms.
  • Once provincially-approved, all non-consent participant materials (i.e. posters, wallet cards, diaries, etc.) are ready for use by all sites (allowing for administrative changes) minimizing the need for re-submission and re-review by the REB.
  • Centre applications generally undergo delegated review.

Ongoing Ethics Review and Oversight

  • During the course of the research, study-wide changes, amendments, documents etc. are submitted at the provincial level, and approved/acknowledged simultaneously for all sites.
  • Sites are responsible for site-specific submissions pertaining to changes or events occurring at their own research site.
  • All ethics submissions are made through CTO Stream and reviewed by the REB of Record.
  • Single ethics expiry date for the study and all research sites in CTO Stream

For information on using CTO Stream to obtain ethics approval, read below.

To learn more about the CTO REB Qualification Program, click here.


Getting Ready to Submit

a) Is CTO right for my study?

b) What are the fees to submit?

c) How to create an account and access the system

d) Accessing Training


Provincial Initial Application (PIA)

a) What is the PIA?

b) Provincial Informed Consent Form Template

c) Required information before starting a submission

d) Starting a new study (creating a PIA)

e) Submitting your completed PIA

f) Screening by CTO

g) REB selection

h) Contacting the REB of Record

i) Responding to review comments from the REB of Record

j) My PIA has been approved. What comes next?


Centre Initial Application (CIA)

a) Centre Initial Application (CIA)

b) Screening by CTO

c) REB Review of your site’s CIA

d) Responding to review comments from the REB of Record


Post-Approval Submissions

a) What happens after the approval of the PIA and CIAs?

b) Who submits what and when?

c) Submitting Continuing Review Forms

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