FACULTY OF NATURAL AND AGRICULTURAL SCIENCES
ETHICS COMMITTEE
C: GENETICALLY MODIFIED ORGANISMS, BIO-HAZARDS AND ENVIRONMENTAL ASPECTS IN RESEARCH AND EDUCATION

NB: All questions marked with * are compulsory

The Ethics Committee endeavors to ensure that research undertaken in the Faculty of Natural and Agricultural Sciences conforms to acceptable standards of ethics in terms of the University of Pretoria regulation reg0205A

According to the Genetically Modified Organisms Act, 1997 (Act No. 15 of 1997) please find the APPLICATION TO REGISTER A FACILITY FOR ACTIVITIES INVOLVING GENETIC MODIFICATION. This has to be done by your facility annually.

*1.Project Title

*2.Researcher(s)

*2.1Principal Researcher

Name / Qualifications / Contact Number / e-Mail Address / Department

*2.2Internal and/or External Co-Researcher(s)

Name / Qualifications

*2.3Graduate Student(s) who may be intending to submit a dissertation or thesis based on this project

Name / Qualifications / Contact Number / e-Mail Address / Department

*2.4Does this project (as set out) have the consent of the co-researcher(s)?

(Please mark with x)

Yes
No

*2.5Does this project (as set out) have the consent of the student(s)?

(Please mark with x)

Yes
No

2.6Student Assistantship(s)

Name / Qualifications

2.7Specialised Services Used

(Example: Statistician, Analyst, etc.)

Name / Qualifications

*3Intended degree

(Please mark with x)

Degree
a. Honours
b. Masters
c. Docorate
Not applicable

*4.Funding

*4.1Is this project fully funded?

(Please mark with x)

Yes
No

*4.1.1If yes, please provide the contact details of the funding body

Name / Contact Details

*4.2Does the funding of the project depend on the project being approved by the Ethics Committee?

(Please mark with x)

Yes
No

5.Data

*5.1Recording and archiving data In terms of the University regulation Policy for the Preservation and Retention of Research Data (Rt306/07), researchers must indicate the manner in which the accumulated from this research trial or obtained from an external source is to be archived. This is to avoid disputes over authenticity and intellectual property.

5.1.1Recording data at the point of measurement

(Please mark with x)

Laboratory book
Logged electronically
Voice recorded
Other forms
If other, please describe:

5.1.2Archiving data

(Please mark with x)

Written / printed
Electronically

*6.Intellectual property and conflict of interest: Declare the interests in the intellectual property of this research project by the participating institutions (university or research, financial or other institution), or persons (project supervisor, research leader, student or other persons).Examples: a: Data provided by FNB to study poverty in Gauteng. FNB relinquishes all IP to the UP.b: Prof XYZ is the project supervisor, while Mr. J is the PhD candidate analysing the data with the assistance of the IT Dept. The participants agree that the IP resides equally with all persons, and that the PhD candidate has the first option to be principal author of research papers.

a. Institutions

b. Persons

c. Conflict of interest

(Is there a conflict of interest between researchers and the part that owns the data? If so, explain any such conflict of interest)

*7.Aim of the Project

(This is the main question(s) being posed)

*8.Scientific justification to use data sets supported by relevant scientific literature

*9.Methods

(Detail procedures required))

*10.Conduct with regard when information become irrelevant / when the project is stopped

*11.Estimated starting date and duration of the project

Starting Date / Duration

*12.Full Description of Type of Test Material

12.1In the case of material imported, ?????????

13.Bio-hazards - Does the project pose a potential bio-hazard as a result of treatment or material waste, or any other outcome?

(Please mark with x)

Yes
Technology
Micro-organisms
Chemical waste
Animal/Plant material
Other forms
If other, please describe:
No

14.Precautionary measures in the case of existing bio-hazards

14.1Protect Staff

14.2Protect Public

14.3Protect Environment

15.Where will this project be carried out?

15.1Is facility registered at the DoA?

(Please mark with x)

Yes
No
Not applicable

*13.Estimated starting date and duration of the project

Starting Date / Duration

14.Planned Application/Announcement of Results

(Please mark with x)

Thesis/Dissertation
Scientific Journal
Contract Report
Direct application in industry
Popular Scientific Publication
Report for an Award

*13.Will this project contribute to your Department’s academic programme?

(Please mark with x)

Yes
No

14.Secrecy clause and Ltd Pty issues when outside companies are involved

(Please provide details if any)

15.Commencement of Research

(Declare that project has not commenced without protocol being approved)

16.Literature References

Researcher:
Signature / Student:
Signature
Date / Date
BIOHAZARDS 2011 / Tel: Number 012 420 4107
Fax: Number 012 420 3290