CONSENT FORM FOR AN INTERVIEW WITH PHOTOS AND/OR VIDEOS
1. Information on the research project
You have been invited to participate in the following research project:
SPECIFY THE TITLE OF YOUR RESEARCH PROJECT HERE (REMEMBER TO REMOVE ALL INSTRUCTIONS IN GREY BEFORE SUBMITTING THE DOCUMENT TO THE REB.)
This project is being conducted by:
YOUR STATUS (EX. PROFESSOR, MASTER’S OR PH.D. STUDENT) YOUR NAME, YOUR EMAIL ADDRESS, YOUR TELEPHONE NUMBER
SUPERVISOR, CO-SUPERVISORS, CO-INVESTIGATORS, THEIR NAMES, EMAIL ADDRESSES, TELEPHONENOs.:
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Master’s OR Ph.D. student, HEC Montréal:
YOUR NAME
Tel.: 000-000-0000
Email:
Supervisor:
NAME
Tel.: 000-000-0000
Email:
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Summary: PROVIDE A BRIEF SUMMARY OF YOUR RESEARCH PROJECT, USING LANGUAGE THAT RESPONDENTS CAN EASILY UNDERSTAND (AVOID JARGON). MAXIMUM OF 5 LINES.
2. Research ethics considerations
IF YOUR PROJECT REQUIRES THAT YOU OBTAIN THE ORGANIZATION’S CONSENT, YOU MUST INCLUDE THE FOLLOWING STATEMENT: Your organization has agreed to participate in this research project. IF THE ORGANIZATION HAS IDENTIFIED THE RESPONDENTS OR GIVEN YOU A LIST OF RESPONDENTS, KEEP THE FOLLOWING STATEMENT. OTHERWISE, REMOVE IT. Your organization provided us with your name as a potential respondent for this research project. Your participation in this research project is strictly voluntary. You have the right to refuse to answer any of the questions. In addition, you may ask to end the interview at any time, in which case the researcher would be prohibited from using the information gathered.
HEC Montréal’s Research Ethics Board has determined that the data collection related to this project meets the ethics standards for research involving humans. If you have any questions related to ethics, please contact the REB secretariat at (514) 340-6051 or by email at . Do not hesitate to ask the researcher any questions you might have.
3. Confidentiality of personal information gathered
You should feel free to answer the questions frankly. The researcher, as well as all other members of the research team, if applicable, undertake to protect the personal information obtained by ensuring the protection and security of the data gathered from participants, by keeping all recordings in a secure location, by discussing the confidential information obtained from participants only with the members of the research team and by refraining from using in any manner data or information that a participant has explicitly requested be excluded from the research.
Furthermore, the researchers undertake not to use the data gathered during this project for any purpose other than that intended, unless approved by HEC Montréal’s Research Ethics Board. Please note that by consenting to participate in this research project, you also consent that the data gathered may be used for future research projects, subject to approval of any such projects by HEC Montréal’s Research Ethics Board.
All persons who may have access to the content of your interview, as well as the person in charge of transcribing the interview, have signed a confidentiality agreement.
4. Protection of personal information in the publication of research results
The information that you provide will be used to produce a document that will be made public. Although the raw information will remain confidential, the researcher will use this information in the work submitted for publication. It is up to you to indicate the level of protection of your personal information that you would like with regard to the publication of the research results.
KEEP ONLY THOSE OPTIONS THAT YOU PLAN TO ACTUALLY USE. FOR EXAMPLE, IF YOU DO NOT PLAN TO DISCLOSE NAMES IN YOUR RESULTS, YOU DO NOT NEED OPTION 1. MOREOVER, THE OPTIONS SHOULD REFLECT YOUR SPECIFIC SITUATION. FOR EXAMPLE, INDICATE WHETHER YOU INTEND TO MENTION THE NAME OF THE ORGANIZATION, OR WHETHER YOU INTEND TO REFER TO THE RESPONDENTS AS MANAGERS, EMPLOYEES OR OTHERWISE IN THE RESEARCH RESULTS. THIS SHOULD ALSO BE SPECIFIED TO THE RESPONDENT.
- Level of confidentiality
Option 1:
I give my consent for my name and title to be disclosed in the dissemination of the research results.
If you check this box, the researchers can quote you from your interview and mention your name and title in any documents or research articles produced following this study. REMOVE ONE OF THE FOLLOWING GROUPS OF SENTENCES IN ORDER TO KEEP ONLY THAT WHICH APPLIES TO YOUR PROJECT: In addition, the name of your organization will be mentioned. You should not expect your anonymity to be protected in this case. OR: Even if the name of your company is not mentioned, you should not expect your anonymity to be protected in this case.
Option 2:
I give my consent for my title only to be disclosed in the dissemination of the research results.
If you check this box, no information concerning your name will be disclosed in the dissemination of the research results. REMOVE ONE OF THE FOLLOWING GROUPS OF SENTENCES IN ORDER TO KEEP ONLY THAT WHICH APPLIES TO YOUR PROJECT. However, the name of your organization will be mentioned. It is therefore possible that someone could obtain your name by cross-referencing. Consequently, you should not expect protection of your anonymity. OR: Even if the name of your company is not mentioned, it is possible that someone could obtain your name by cross-referencing. Consequently, you should not expect protection of your anonymity.
Option 3:
I do not want either my name or my title to appear in the dissemination of the research results.
If you check this box, neither your name nor your title will be disclosed in the dissemination of the research results. REMOVE ONE OF THE FOLLOWING GROUPS OF SENTENCES IN ORDER TO KEEP ONLY THAT WHICH APPLIES TO YOUR PROJECT. However, the name of your organization will be mentioned. It is therefore possible that someone could obtain your name by cross-referencing. Consequently, complete protection of your anonymity cannot be assured. OR: Even if the name of your company is not mentioned, it is possible that someone could obtain your name by cross-referencing. Consequently, complete protection of your anonymity cannot be assured.
B) Photographs or audiovisual recordings (INDICATE ONE OR THE OTHER)
- Consent for audio recording of the interview:
REMOVE THIS FIRST SECTION IF IT DOES NOT APPLY TO YOUR PROJECT (FOR EXAMPLE, IF YOU INTEND TO MAKE A VIDEO RECORDING OF THE INTERVIEW):
I give my consent for the researcher to make an audio recording of this interview.
I do not give my consent for the researcher to make an audio recording of this interview.
INDICATE ONLY THE OPTION BELOW THAT APPLIES TO YOUR PROJECT
I give my consent for PHOTOGRAPHS OR AUDIOVISUAL RECORDINGS of myself to be used by the researcher and to appear in the dissemination of the research results.
You should not expect your anonymity to be protected in this case.
OR
I give my consent for PHOTOGRAPHS OR AUDIOVISUAL RECORDINGS (INDICATE ONLY THE OPTION THAT APPLIES TO YOUR PROJECT) of myself to be used by the researcher for the purpose of analyzing the data.
If you give your consent, all PHOTOGRAPHS OR VIDEOS (INDICATE ONLY THE OPTION THAT APPLIES TO YOUR PROJECT) will remain confidential; they will be protected by a password and kept under lock and key. These PHOTOGRAPHS OR VIDEOS will never be published or disseminated publicly in any way. Only the researchers involved in the project will have access to these PHOTOGRAPHS OR VIDEOS.
You can signify your consent either with your signature, by email or verbally at the beginning of the interview.
PARTICIPANT’S SIGNATURE:
First and last name: ______
Signature: ______Date (dd/mm/yyyy): ______
RESEARCHER’S SIGNATURE:
First and last name: INDICATE YOUR NAME______
Signature: ______Date (dd/mm/yyyy): ______
YOU MUST SIGN THIS DOCUMENT ONLY IN THE PRESENCE OF THE RESPONDENT AND GIVE HIM/HER A SIGNED COPY.
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