Cowichan Tribes’ territory, located in the Cowichan Valley on Vancouver Island, British Columbia, Canada, is experiencing an alarmingly high rate of preterm births compared to the national average of Indigenous Peoples in Canada. In response, and in partnership with the First Nations Health Authority (FNHA), Cowichan Tribes is in the first year of a 3-year study to investigate causes. Cowichan Tribes’ Elders and community members are guiding the study to ensure it follows Cowichan Tribes’ research processes and to support self- determination in research. Furthermore, as a way to enhance reconciliation, Elders and community members guided an on-site ethics review on Cowichan Tribes territory. This article outlines the collaborative, in-person research ethics review process that Cowichan Tribes, Island Health, and FNHA completed on August 21, 2019. The purpose of this article is to provide suggestions other First Nations could use when conducting a research ethics review, and to explain how this process aligns with the principles of ownership, control, access, and possession (OCAP®), the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission of Canada, and above all, the Cowichan snuw’uy’ulh (teachings from Elders).