Sample - Ethics Review Result Form

Doc. No. : UC-ERC-SOP-FT06 Ver. No. : 01 Ver. Date. : 03.15.
2013
Governor Pack Road, Baguio City,
Philippines 2600
Tel. No.: (+6374) 442-3316, 442-8220; 444-2786;
442-2564; 442-8219; 442-8256; Fax No.: 442-6268 Effectivity Date: June 1, 2013 Page 1 of 5
Email: ucf_bcfresearch@yahoo.com;
Website: www.uc-bcf.edu.ph
ERC Standard Operating

Procedures
Ethics Review Result Form
Title of Project
Type of Project
(GIA, Loads-off, Externally Funded)
Name of Proponent/s
College/Department
Contact Information
Email address and phone number
Kind of Review Needed
Time Frame of the Research
RISKS TO, AND SAFETY OF, RESEARCHERS

Do any of those named above need appropriate Yes/No
training to enable them to conduct the proposed
research safely and in accordance with the ethical
principles set out by the College?
Are any of the researchers likely to be sent or go Yes/No

to any areas where their safety may be
compromised, or they may need support to deal
with difficult issues?
Could researchers have any conflicts of interest? Yes/No
RISKS TO, AND SAFETY OF, PARTICIPANTS

Could the research induce any psychological Yes/No
stress or discomfort?
Prepared by: Reviewed & Approved by:
CARLJOHNSON G. ANACIN DR. CLEOFAS M. BASAEN

Committee Member, UC-ERC VP for Academic Affairs
Date: Date:
Doc. No. : UC-ERC-SOP-FT06 Ver. No. : 01 Ver. Date. : 03.15.2013
Philippines 2600
Tel. No.: (+6374) 442-3316, 442-8220; 444-2786;

Procedures
Does the research involve any physically invasive Yes/No

or potentially physically harmful procedures?
Could this research adversely affect participants in Yes/No

any other way?
DATA PROTECTION
Will any part of the research involve audio, film Yes/No
or video recording of individuals?
Will the research require collection of personal Yes/No

information from any persons without their direct
consent?
How will the confidentiality of data, including the

identity of participants (whether specifically
recruited for the research or not) be ensured?
Who will be entitled to have access to the raw

data?
How and where will the data be stored, in what

format, and for how long?
What steps have been taken to ensure that only

entitled persons will have access to the data?
How will the data be disposed of?
How will the results of the research be used?
What feedback of findings will be given to

participants?
Is any information likely to be passed on to Yes/No

external companies or organisations in the course
of the research?

Date: Date:
Philippines 2600
Tel. No.: (+6374) 442-3316, 442-8220; 444-2786;

Procedures
Will the project involve the transfer of personal Yes/No

data to countries outside the European Economic
Area?
RESEARCH DESIGN
The research involves living human subjects Yes/No
specifically recruited for this research project
If ‘no’, go to section 6
How many participants will be involved in the
study?
What criteria will be used in deciding on

inclusion/exclusion of participants?
How will the sample be recruited?
Will the study involve groups or individuals who Yes/No

are in custody or care, such as students at school,
self help groups, residents of nursing home?
Will there be a control group? Yes/No
What information will be provided to participants

prior to their consent? (e.g. information leaflet,
briefing session)
Participants have a right to withdraw from the

study at any time. Please tick to confirm that
participants will be advised of their rights,
including the right to continue receiving services
if they withdraw from the study.
Will it be necessary for participants to take part in Yes/No

the study without their knowledge and consent?
(e.g. covert observation of people in non-public
places)

Date: Date:
Philippines 2600
Tel. No.: (+6374) 442-3316, 442-8220; 444-2786;

Procedures
Where consent is obtained, what steps will be

taken to ensure that a written record is
maintained?
In the case of participants whose first language is

not English, what arrangements are being made to
ensure informed consent?
Will participants receive any financial or other Yes/No

benefit from their participation?
Are any of the participants likely to be particularly Yes/No

vulnerable, such as elderly or disabled people,
adults with incapacity, your own students,
members of ethnic minorities, or in a professional
or client relationship with the researcher?
Will any of the participants be under 16 years of Yes/No
age?
Do the researchers named above need to be Yes/No

cleared through the Disclosure Scotland
procedures?
Will any of the participants be interviewed in Yes/No

situations which will compromise their ability to
give informed consent, such as in prison,
residential care, or the care of the local authority?
EXTERNAL PROFESSIONAL BODIES

Is the research proposal subject to scrutiny by any Yes/No
external body concerned with ethical approval?
If so, which body?
Date approval sought

Date: Date:
Philippines 2600
Tel. No.: (+6374) 442-3316, 442-8220; 444-2786;

Procedures
Outcome, if known or
Date outcome expected
ISSUES ARISING FROM THE PROPOSAL
In my view, ethical issues have been satisfactorily addressed, OR
In my view, the ethical issues listed below arise and the following steps are being taken to address them:
Signature
Date
Reviewed by:
Signature over printed name Signature over printed name

Date: Date:
Signature over printed name Signature over printed name

Date: Date:

Date: Date:

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Doc. No. : UC-ERC-SOP-FT06 Ver. No. : 01 Ver. Date. : 03.15.

ERC Standard Operating

Kind of Review Needed

Time Frame of the Research

RISKS TO, AND SAFETY OF, RESEARCHERS

Are any of the researchers likely to be sent or go Yes/No

Could researchers have any conflicts of interest? Yes/No

RISKS TO, AND SAFETY OF, PARTICIPANTS

Prepared by: Reviewed & Approved by:

CARLJOHNSON G. ANACIN DR. CLEOFAS M. BASAEN

ERC Standard Operating

Does the research involve any physically invasive Yes/No

Could this research adversely affect participants in Yes/No

Will the research require collection of personal Yes/No

How will the confidentiality of data, including the

Who will be entitled to have access to the raw

How and where will the data be stored, in what

What steps have been taken to ensure that only

How will the data be disposed of?

How will the results of the research be used?

What feedback of findings will be given to

Is any information likely to be passed on to Yes/No

Prepared by: Reviewed & Approved by:

CARLJOHNSON G. ANACIN DR. CLEOFAS M. BASAEN

ERC Standard Operating

Will the project involve the transfer of personal Yes/No

What criteria will be used in deciding on

How will the sample be recruited?

Will the study involve groups or individuals who Yes/No

Will there be a control group? Yes/No

What information will be provided to participants

Participants have a right to withdraw from the

Will it be necessary for participants to take part in Yes/No

Prepared by: Reviewed & Approved by:

CARLJOHNSON G. ANACIN DR. CLEOFAS M. BASAEN

ERC Standard Operating

Where consent is obtained, what steps will be

In the case of participants whose first language is

Will participants receive any financial or other Yes/No

Are any of the participants likely to be particularly Yes/No

Do the researchers named above need to be Yes/No

Will any of the participants be interviewed in Yes/No

EXTERNAL PROFESSIONAL BODIES

If so, which body?

Date approval sought

Prepared by: Reviewed & Approved by:

CARLJOHNSON G. ANACIN DR. CLEOFAS M. BASAEN

ERC Standard Operating

Date outcome expected

ISSUES ARISING FROM THE PROPOSAL

In my view, ethical issues have been satisfactorily addressed, OR

Signature over printed name Signature over printed name

Signature over printed name Signature over printed name

Prepared by: Reviewed & Approved by:

CARLJOHNSON G. ANACIN DR. CLEOFAS M. BASAEN

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