Ethics Certificate Form Checklist (ECFC)

SECTION A / Please tick this column when you have completed each category on the Ethics Clearance Form
A1 / Surname & Name
A2 / Title
A3 / Department/ Division
A4 / Staff/ student number / - Use your student number even if you are also staff
A5 / Name of Supervisor / -Supervisor name must match I2
SECTION B
B1 / Title of research / - Please write your research title as it appears on the proposal.
B2 / Is this research for degree purposes?
B3 / If so, for what degree?
B4 / Has it been approved by a properly constituted research panel or supervisor?
B5 / Does this research involve human participants?
SECTION C
C1 / Where will the research be carried out? / - You need to be specific about, where the research will be carried out. e.g. where exactly in Johannesburg will the research take place.
C2 / What are the aims & objectives of the research? / - You need to clarify the aims, and then clarify the objectives separately.
C3 / Has appropriate formal permission been obtained, If required (e.g. employer, land owner, government department etc.)? / -If research involves human participants, permission must be obtained. E.g, if you are surveying students from Wits, the Registrar’s permission is required; if you are surveying shoppers from a shopping centre (e.g. Woolworths) or outside any shopping centre, permission must be obtained from the management of the shopping centre.
- Permission should be on official letterhead of the organisation concerned, and should be addressed to you as the researcher.
When research participants are school children, you need permission from the Department of Education, the School Principal, the learner, and the parent or guardian irrespective whether the learner is above 14 or not.
C4 / Do you have any financial or material interest associated with your research participants or with the organisations that you will work with during your research? / -If answer is Yes , C5 below is mandatory.
C5 / If yes, please explain how you will manage any existing or potential conflicts of interest
SECTION D
D / How will data on human research participants be collected? / -More than one option may be necessary.
Please note: if it is a taped interview, permission to tape record must be appended as a separate form to the informed consent form. Please see template SCIR.
SECTION E
E1 / Who will the research participants be?
E2 / What is the age range or minimum age? / - E.g. ‘18 +’. If under 14, guardian permission must be appended (see page 6 of the guidelines). Please also ensure that age ranges do not overlap, e.g. 21-25; 26-30 and not 21-25; 25-30.
E3 / Does this research expose either the participant or the researcher to any potential risks of harm that they would otherwise not be exposed to?
E4 / Will research involve vulnerable categories?
E5 / If so, state which ones:
E6 / How will any existing vulnerabilities among research participants be addressed? / - Researcher may need to submit CCDU letter/email confirming standby if E4 is YES. Additionally, the contact details of the therapist on standby must then be included on the participation letter.
SECTION F
F1 / Can participants’ confidentiality be guaranteed?
F2 / Can anonymity be guaranteed in resulting reports, thesis or publications?
F3 / (a)Explain how this will be done?
(b)What will participants be told in this
regard? / -An explanation rather than a statement is required.
-Please write in full exactly what the participants will be told.
DOCUMENTATION
Have all the documents been proofread?
Does information in the application form match supporting documents?

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