Scribd
Upload
15 views3 pages

USC REC F-32 - Research Protocol Application Form (1).docx

The document is a research protocol application form submitted to the University of San Carlos Research Ethics Committee for a study titled 'Assessing Food Waste of Selected Food Establishments in Nasipit, Talamban, Cebu City.' The study, led by researchers Shinlyn S. Baniel and Anna Marie Liza S. Donaire, aims to assess food waste in 20 food establishments from September 15, 2023, to July 25, 2024, and is researcher-funded. The researchers have declared their awareness of ethical aspects and have consented to the terms outlined by the committee.

Uploaded by

ALMA BANIEL
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
15 views3 pages

USC REC F-32 - Research Protocol Application Form (1).docx

The document is a research protocol application form submitted to the University of San Carlos Research Ethics Committee for a study titled 'Assessing Food Waste of Selected Food Establishments in Nasipit, Talamban, Cebu City.' The study, led by researchers Shinlyn S. Baniel and Anna Marie Liza S. Donaire, aims to assess food waste in 20 food establishments from September 15, 2023, to July 25, 2024, and is researcher-funded. The researchers have declared their awareness of ethical aspects and have consented to the terms outlined by the committee.

Uploaded by

ALMA BANIEL
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

University of San Carlos Research Ethics Committee

REC Form No: 32


Research Protocol Application Form Version No. 07-02
Effective Date: 07/11/22

INSTRUCTIONS:
1. For protocols with multiple researchers/proponents, the designated project leader must
be listed first in the roster of names
2. Please read and understand fully the Data Privacy Consent Form. Accomplish two (2)
copies of the said form should you fully agree to the stipulations therein.
3. After having accomplished two (2) copies of the Data Privacy Consent Form, please
accomplish one (1) copy of this application form and attach all required documents.

APPLICATION DETAILS
Protocol Code:
Protocol Title: Assessing Food waste of Selected
Food Establishments in Nasipit Ver. 1
Talamban, Cebu City
Researcher(s)/
Shinlyn S. Baniel and Anna Marie Liza S. Donaire
Proponent(s):
Date of
Submission:
Type of Study
Clinical Trial Social / Behavioral Stem Cell Research
(Sponsored) Research
Clinical Trials Public Health / Genetic Research
(Researcher-initia Epidemiologic
ted) Research
Health Operations Biomedical research / Others: Assessing study
Research (Health (Retrospective,
Programs and Prospective and
Policies) diagnostic studies)
Approximate Duration Proposed Start Date: End Date:
of the Study 15/09/2023 25/07/2024
Expected number of
20 Food establishments
participant(s):
Study Site: Nasipit Talamban, Cebu City
Source(s) of Funds: Researcher-Funded
Institution: University of San Carlos - Talamban Campus
Institution Address: Nasipit Talamban, Cebu City, Philippines, 6000

Contact Information of Researcher(s)/Proponent(s):


Mailing Address: N/A
Email: [email protected] and [email protected]
University of San Carlos Research Ethics Committee
REC Form No: 32
Research Protocol Application Form Version No. 07-02
Effective Date: 07/11/22

Contact Number(s): 09260055887 and 09272068033

Declaration(s) by the Researcher(s)/Proponent(s):


(please tick the items below)

✔ I am aware of the ethical aspects of this research project.


✔ I hereby grant my express consent to USC REC, its officer/s, its member/s, independent
consultant/s, and all person/s involved in the conduct of the review of my/our protocol and
anything related to it, such as but not limited to: collection, use, share, storage, protection, and
access of all types of personal information.
✔ I commit and submit the Continuing Review Approval Form on an annual basis to the
University of San Carlos Research Ethics Committee (USC REC).
✔ I will ensure that changes in approved research protocols are reported promptly and are not
initiated without approval by the USC REC, except when necessary to eliminate apparent
immediate hazards to the participant(s).
✔ I will ensure that all adverse or unforeseen problems arising from the research project are
reported in a timely fashion to the USC REC.
✔ I will provide notification when the study is complete and if it fails to start or is abandoned.

Conflict of Interest (COI) (please tick the appropriate item):


✔ I hereby declare that I have no actual or potential conflict of interest in this protocol
◻ I hereby declare that I have either an actual or potential conflict of interest in this protocol,
please specify the COI here:

__________________________________________________________
__________________________________________________________

Signature of Date: June 13, 2024


Proponent(s)/
Researcher(s):
Shinlyn S. Baniel

Anna Marie Liza S. Donaire

FOR FURTHER INFORMATION, CONTACT:

USC REC SECRETARIAT


University of San Carlos Research Ethics Committee
REC Form No: 32
Research Protocol Application Form Version No. 07-02
Effective Date: 07/11/22

University of San Carlos, Nasipit, Talamban, Cebu City


(032) 230-0100 loc. 204
Email: [email protected]

You might also like