Assessment of Ethics in Research Form

ITT Dublin RE_1 Form

To be completed by staff proposing to submit an application to conduct research.

Completed forms should be returned to the Head of Department.

1. Project Title:
2. Applicant Details (Use Block Capitals):
Name:
Dept. & School:
Present position:
Contact details: / Tel: / E-mail:
3. Collaborating researchers / Institutions / Organisations:
Name:
Dept. & School:
Present position:
Contact details: / Tel: / E-mail:
4. Source of Funding: Agency: / Amount: €
5. Has this research project already received approval from another Research Ethics Committee?
Delete Yes or No as appropriate: Yes: . NO: .
If Yes, please submit a completed Ethical Approval from Other Committees Form; letter of approval from that REC and a copy of the official decision of that REC
6. Has the proposal been submitted to, and been rejected by any other Research Ethics Committee?
Delete Yes or No as appropriate: Yes: . NO: .
If Yes, please submit a completed Ethical Approval from Other Committees Form and a copy of the official decision of that REC
6. Insurance: Normally, ITT Dublin insurance covers standard research activity.
  • Are there any unusual or exceptional risks or insurance issues to which ITT Dublin’s insurance company should be alerted? If so, please list the issues: (use a separate sheet if necessary)
No contract should be entered into for clinical/medical (including drug testing) or surgical trials/tests on human subjects until written confirmation has been received from the ITT Dublin’s insurers that the relevant insurance cover is in place.
7. Ethical issues:Does your research propose to involve any of the following during the course of the project? Please put an X in the appropriate YES or NObox, as appropriate, below.
Full ethics clearance by the Institute’s Research Ethics Committee is required where a YES answer has been entered for any one of the categories below following the steps set out in the Institute’s Ethics Procedures.
Ethical issues: /

Yes

/

No

  1. Human experimentation – including surveys, behavioural observation etc.

  1. Animal experimentation

  1. Clinical trials involving human participants

  1. Research involving human remains, cadavers, tissues, discarded tissue (e.g. placenta), and biological fluids

  1. Genetic manipulation

  1. Use of know teratogens, carcinogens and any cytotoxic substances in clinical trials

  1. Use of harmful substances in human or animal participants

  1. Use of ionising radiation with human participants in research

  1. The possibility of a conflict of interest due to financial incentives / benefits from a sponsor

  1. The collection, storage and use of data of a sensitive or confidential nature

  1. The potential for conflict over authorship; fair recognition of all the participants an the research

  1. Emerging areas of research not yet listed or any research where the researcher is uncertain of the requirement

Ethics clearance is a requirement of some research funding agencies:
Is ethical clearance is a stated requirement of the funding agency?
If other risk and/or ethical issues are identified please provide an outline of these issues and the manner in which they will be addressed (use a separate sheet if necessary).
7. RESEARCH ETHICS DECLARATION All academic researchers are obliged to complete and sign the Ethics Declaration below.
In accordance with the ITT Dublin Code of Good Research Practice, I declare that the information provided in this form is true to the best of my knowledge and judgement.
I will advise the Head of Department and the Research Ethics Committee of any adverse or unforeseen circumstances or changes in the research which might concern or affect any risks or ethical issues, including if the project fails to start or is abandoned.
Signature of applicant 1: / Date:
Signature of applicant 2: / Date:
Signature of applicant 3 / Date: