HRECComplaints Report Form

In the event that a complaint has been raised by a participant regarding their involvement in aHREC (Human Research Ethics Committee) approved research project, the site PrincipleInvestigator must complete and submit this report form.

  • Once completed forms must be submitted to all approving HREC’s.
  1. RESEARCH PROJECT DETAILS

HREC Approval number / HREC Approval Date
Project Title
  1. SITE REPORT DETAILS

Principal Investigator Details

Title / Given Name / Family Name
Institution / Email

Chief Investigator Details

Title / Given Name / Family Name
Institution / Email

Co-Investigator/s Details

Title / Given Name / Family Name
Institution / Email

*Click the blue cross to the right for additional tables for Co-Investigator details

  1. COMPLAINT DETAILS

Date Complaint Received Click here to enter a date. / Name of Complainant
Relationship of complainant to research project
Format of Complaint Choose an item. / Date Complaint Resolved Click here to enter a date.

Summary of the complaint

Click here to enter text.

Explain the impact of the complaint on the research project and its continuation

Click here to enter text.

Summarise the action taken regarding the complaint

Click here to enter text.

Describe the outcome of the action taken

Click here to enter text.

Detail any further action required

Click here to enter text.

  1. DECLARATION

I have included all copies of evidence that support this complaint including all communication with the complainant.

  • I confirm that this project is being conducted in keeping with the conditions of approval of the reviewing HREC (and subject to any changes subsequently approved).
  • I confirm that the project is being conducted in compliance with the NHMRC National Statement on Ethical Conduct in Human Research (NHMRC, 2007) or as amended.
  • I confirm that I have not received any information in any form from anyone involved in the research project to suggest this report does not accurately reflect the progress of the project at the above site(s).

Principal Investigator
Signature / Date
Chief Investigator
Signature / Date

OFFICE USE ONLY

Date received Click here to enter a date. / Date reviewed by HREC Secretary Click here to enter a date.
Submitted to HREC Click here to enter a date. / Reviewed by HREC Click here to enter a date.

Australian College of Natural Medicine Pty Limited (ACNM) trading as Endeavour College of Natural Health, FIAFitnation, College of Natural Beauty, Wellnation

(National CRICOS Provider #00231)

HREC Complaints Report Form - F-214 / Effective Date: 30-Nov-17
Version: 1.0 / Page 1 of 2