/ Human Research Ethics Committee
Progress Report/Request for Extension Form
Progress reports are required annually, on the anniversary of initial approval for the project, and at the completion of the project. Please ensure that any requests to extend HREC approval are submitted at least twelve weeks prior to the date of HREC approval expiry. Failure to comply with reporting requirements may result in suspension of approval for your research project.
To complete this form electronically save the form, and complete it using Microsoft Word. Alternatively, you may print this form out and complete it manually.
Please submit 2hard copies of this form and a soft to the Secretary, Human Research Ethics Committee, Bendigo Health Care Group, P.O. Box 126, Bendigo, Victoria, 3552 ()

Please indicate:[double click on box, fill ‘checked’ default value in ‘Properties’, then ‘OK’]

Annual Progress Report Extension Requested Yes No

Final Progress Report

Researcher Details

Project Title
HREC Reference No
Date of HREC approval
Expiry date of HREC approval
Progress report due date
Progress report submission date
Contact name
Contact phone number
Address Details
If this is a supervised project please indicate:
1. Level of project: / Honours / Masters / PhD
Other / Please specify:
2. Supervisor name
3. Supervisor Position and Qualification (e.g. PhD, M.D.)

Research Progress

Current status of project
Has the project commenced? / Yes
Date of commencement / No
Expectedcommencement date
Data collection: / not started / continuing / completed
Data analysis: / not started / continuing / completed
Has the project been completed?
completed? / Yes
Date of completion / No
Expected completion date
Has the project been discontinued? / Yes / Date project discontinued
Provide reasons (attach further information if required)
Other (please describe):
Adverse event
  1. Have any adverse events been reported for this project?
/ Yes No
  1. If yes, have reports been forwarded to the Bendigo Health HREC?
/ Yes No
  1. If no, why not? Please provide details.

  1. Have any participants withdrawn from the project?
/ Yes No
  1. If yes, please provide details.

Complaints
  1. Have any participants lodged a complaint regarding this project?
/ Yes No
  1. If yes, have copies of the complaints been forwarded to the HREC?
/ Yes No
  1. If no, why not?

Research protocol
  1. Have you deviated from the research methodology as detailed in the original protocol or approved amendments?
/ Yes No
  1. If yes, please explain.

Participant information
  1. Have all research participants received and read (or had read tothem) the required participant information?
/ Yes No
  1. Have all research participants (or appropriate approvedrepresentatives)signed consent forms?
/ Yes No
  1. If no, please explain.

Data security
  1. Is the data stored securely with due regard to privacy concerns?
/ Yes No
  1. If no, please explain

Other issues
  1. Were there any other issues concerning this project that theHREC should be aware of?
/ Yes No
  1. If yes, please explain.

Research summary
  1. Please attach a summary of research project progress. This summary should be no more than one page and should include:

  1. A brief statement of the aims of the research project.

  1. A brief overview of the method, including number of participants and reasons for withdrawal of participants, if applicable.

  1. A summary of any research findings.

  1. A summary of future work to be conducted on the project, if applicable.

  1. A summary of problems that have arisen during the conduct of the research project, particularly those that bear on the capacity of the project to be completed within the approved time frame.

  1. A list of publications or conference presentations of the research project. The committee would appreciate a copy of any research publications.

Request for Extension
  1. Do you require an extension to the current HREC approval?
/ Yes No
  1. If yes, until what date?

  1. For what reason/s is an extension to HREC approval required?

Principal Investigator Name

/

Signature

Date

Supervisor name (if applicable)

/

Signature

Date

G:\CHERC\ETHICS COMMITTEE\Application Pack\2016\Progress Report Template 0316.docx

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