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Inform Consent Checklist (Do Not Submit- Only Guide for Inform Consent Contextualization)

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25 views

Inform Consent Checklist (Do Not Submit- Only Guide for Inform Consent Contextualization)

Uploaded by

kkue53850
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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SAMAR STATE UNIVERSITY

Arteche Blvd., Catbalogan City, Philippines 6700


Office of the Institutional Human Research Ethics
SSU-IHREC-EA-016
O8-AUG-2023 REV.2

INFORMED CONSENT CHECKLIST

Title of Study Online Motor and Fishing Boats Monitoring System in Catbalogan City

Type of
REC Code
Review
Institutio
Proponent
n
Primary
Reviewer Yes No
reviewer
Guide questions for reviewing the informed consent process and form
Is it necessary to seek the informed consent of the participants? Unable to Assess Yes
No
If NO, please explain.

If YES, are the participants provided with sufficient information


regarding:
 Purpose of the study? Yes No
 Expected duration of participation? Yes No
 Procedures to be carried out? Yes No
 Discomforts and inconveniences? Yes No
 Risks (including possible discrimination)? Yes No
Not applicable Yes
 Random assignment to the trial treatments?
No
 Benefits to the participants? Yes No
Not applicable Yes
 Alternative treatments/ procedures?
No
 Compensation and/or medical treatments in case of injury? Yes No
 Who to contact for pertinent questions and / or for assistance in a
Yes No
research- related injury?
 Refusal to participate or discontinuance at any time will involve
Yes No
penalty or loss of benefits to which the subject is entitled?
 Extent of confidentiality? Yes No
Is the informed consent written or presented in simple Yes No
language that participants can understand?
Does the protocol include an adequate process for Yes No
ensuring that consent is voluntary?
Do you have any other concerns?

Recommendation: Approved
Minor revisions required

_____________________________________________________

_____________________________________________________

_____________________________________________________

Website: www.ssu.edu.ph
Contact us: (055) 530-0629 | [email protected]
Follow us on @ssucatbalogan 1st Philippine Higher Education Internationalization Awardee (2021)
Page 1 of 3 2019 Top Patent Filer (2009-2019)
SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City, Philippines 6700
Office of the Institutional Human Research Ethics
SSU-IHREC-EA-016
O8-AUG-2023 REV.2

Major revisions required

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

Disapproved

Reasons for disapproval:

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

________________________________ ________________________
Name and Signature of Reviewer Review Date

Website: www.ssu.edu.ph
Contact us: (055) 530-0629 | [email protected]
Follow us on @ssucatbalogan 1st Philippine Higher Education Internationalization Awardee (2021)
Page 2 of 3 2019 Top Patent Filer (2009-2019)
SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City, Philippines 6700
Office of the Institutional Human Research Ethics
SSU-IHREC-EA-016
O8-AUG-2023 REV.2

Website: www.ssu.edu.ph
Contact us: (055) 530-0629 | [email protected]
Follow us on @ssucatbalogan 1st Philippine Higher Education Internationalization Awardee (2021)
Page 3 of 3 2019 Top Patent Filer (2009-2019)

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