RESEARCH AND EXTENSION SERVICES

RESEARCH ETHICS CHECKLIST

(For research involving human participants)

RESEARCHER/S’ DETAILS
RESEARCH TITLE Employee Motivation of Tertiary Education Teachers at
University of Eastern Pangasinan
NAME/S OF Lead Researcher: Buccat, Larisse Jan O.
RESEARCHER/S AND Co-researchers
EMAIL 1. Agbuya, Anthony M.
2. Balanon, Mecaella R.
3. Bello, Edralyn M.
4. Dela Cruz, Jennica C.
5. Fernandez, Richelle Belle L.
6. Galvez, Reynalyn A.
7. Joaqin, Sheryl A.
8. Reyes, Lyka Angel M.
DEPARTMENT/COLLEGE COLLEGE OF ACCOUNTANCY AND BUSINESS
ADMINISTRATION
SEMESTER AND 1st semester AY: 2023-2024
ACADEMIC YEAR

Does your study involve human participants?

✓ yes ___no

* If your answer is “yes”, proceed complying the checklist below

Check the appropriate answer for each question:

SOURCE OF DATA
1. How will the data be gathered? (check all that applied?
_____ personal interview _____ telephone interview
_✓__ internet survey _____ telephone survey
_____ observation _____ focus group
_____ self-administered questionnaire _____ others (specify)
✓ researcher - administered questionnaire
________________________________
_____ Pre- existing data from human participants
(answer the questions below if you check this item)

Where the data of the study be sourced?

Is the data publicly available? ____ yes (indicate where the data set is
available)

____ no (indicate/attach the approval authority

for access)

Was the original data set originally collected ____ yes ( attach the Consent Form used in the
for the present study’s purpose? original study)

____ no ( attach the Information Collection

Statement)

Does the original data set contain sensitive ____ yes (describe the type of sensitive data to
data? be used in the present research)

____ no

Does the original data set have personal ____ yes

identifiers? ____ direct (personal details)
____ indirect (used code)

Research 1
Exhibit 11 -1-2021-22
Research Ethics Checklist
 RESEARCH AND EXTENSION SERVICES
____ no
Will new data be collected and analyzed ____ yes
along with data from the existing data set? ____ no

* Answer the questions below if new data will be collected

SAMPLING DETAILS
Number of respondents 321 Respondents

Location of the respondents University of Eastern Pangasinan

Duration of data collection 4 Months

Who will collect the data? The Researchers

Locale of the study University of Eastern Pangasinan

Employed technique to ensure voluntary Informed Consent

consent from participants?

DATA RETENTION
How long will the data of participant with 3 Years
identifiers be kept after the publication?

How long will the anonymized data be 3 Years

kept after the publication ?

PROCEDURE FOR INFORMED CONSENT

How will informed consent be recorded? (check all that applies)
_✓ Written Consent
____ Audio-recorded Consent
_✓Online/Email recorded Consent
____ Others (specify)

STUDY THAT NEEDS FULL REVIEW

YES NO
1. Will the study involve recruitment of staff/employees of UEP or other ✓
agency?
2. Does the study involve participants age 18 and below who are unable to ✓
give informed consent?
3. Does the research involve potentially vulnerable groups: children, those ✓
with cognitive impairment, or those in unequal relationships?
4. Will there be a possibility that the research can induce physical harm to ✓
the subject?
5. Will there be a possibility that the research can induce psychological ✓
harm to the subject?
6. Will the participants be informed that they will be observed? ✓

7. Will there be a possibility that the research can induce emotional ✓

discomfort to the subject?
8. Will the study require the cooperation of a gatekeeper or another person ✓
in authority for initial access to the groups or individuals to be recruited?
(eg students at school, members of self- help group, residents of nursing

Research 2
Exhibit 11 -1-2021-22
Research Ethics Checklist
 RESEARCH AND EXTENSION SERVICES
home?)
9. Will it be necessary for participants to take part in the study without ✓
their knowledge and consent at the time? (eg covert observation of people
in non- public places)
10. Will the study involve discussion of sensitive topics? (eg sexual ✓
activity, drug use, politics)
11. Are drugs, placebos or other substances (eg food substances, vitamins) ✓
to be administered to the study participants, or will the study involve
invasive, intrusive or potentially harmful procedures of any kind?
12. Will tissue samples (including blood) be obtained from participants? ✓
13. Will genetic samples be extracted from the obtained biological ✓
samples?
14. Is pain or more than mild discomfort likely to result from the study? ✓
15. Could the study induce psychological stress, discomfort, anxiety or ✓
cause harm or negative consequences beyond the risks encountered in
normal life?
16. Will the study involve prolonged or repetitive testing? ✓
17. Will the research involve administrative or secure data that requires ✓
permission from the appropriate authorities before use?
18. Is there a possibility that the safety of the researcher may be in ✓
question? (eg in international research: locally employed research
assistants)
19. Does the research involve members of the public in a research capacity ✓
(participant research)?
20. Does the research involves government officials? ✓
21. Does the research involves top management of an institution, ✓
organization or company?
22. Will the research take place outside the Philippines? ✓
23. Will the research involve respondents to the internet or other ✓
visual/vocal methods where respondents may be identified?
24. Will research involve the sharing of data or confidential information ✓
beyond the initial consent given?
25. Will financial recompense be offered to participants? ✓

Research 3
Exhibit 11 -1-2021-22
Research Ethics Checklist
 RESEARCH AND EXTENSION SERVICES

DECLARATION

I certify that i shall abide to the ethical principle of this study and be responsible in the conduct
of research. I will not commence with the data collection until I receive the approval of the
Research Ethics Committee of University of Eastern Pangasinan.

BUCCAT, LARISSE JAN O. August 3, 2023

Name and signature of Lead Researcher Date

ADVISER’S APPROVAL

In my capacity as their adviser, I confirm that this research had undergone thorough review and
followed the ethical guidelines.

JOLINA A. REYES, MBA August 3, 2023

Name and signature of Adviser (for Students’ research) Date

Noted:

JOLINA A. REYES, MBA August 3, 2023

Name and signature of Program Research Coordinator Date

MONA LIZA D. ABANES PhD August 3, 2023

Name and signature of Program Head Date

RESEARCH ETHICS COMMITTEE APPROVAL FORM

Evaluated: Evaluated: Evaluated:

JAN KARLO THOMAS V. REZZIE P. MENSALVAS ARRA JOYCE M.

RANCHEZ OFFICIAR
REC Member REC Member REC Member

Approved:
GLORIA C. NEMEDEZ
PhD
REC Chairman

Research 4
Exhibit 11 -1-2021-22
Research Ethics Checklist