Submitted to the ÉTS Research Ethics Committee
Researchers who submit a research project for approval by the ÉTS Research Ethics Committee must read the Tri-Council Research Policy Statement entitled Ethics on Research Involving Humans (2014). This document describes the ethical guidelines for research projects that involve the participation of human beings. Applicants must fill out this form and sign it to certify that they have read the Policy Statement (TCPS, 2014) and that they agree with all the information listed on this form.
Ethics CodeProject title:
Research project dates: / Start date: Click here to enter date / End date: Click here to enter date
Has another ethics certificate been requested/Will another ethics certificate be requested?
☐ Yes ☐ No
If Yes, specify the name of the ethics committee:
If another ethics certificate has already been obtained, please attach it to this application.
Do you expect to publish one or more scientific papers?
☐ Yes ☐ No
Principal investigator information
Name:
☐ Professor / ☐ Adjunct Professor / ☐ Researcher / ☐ Instructor (CEGEP)
Role in the project:
ÉTS: / Other:
Co-Researcher information (Research staff, student or other)
Name: / ☐ Student
Role in the project:
Affiliation:
Email address:
Name: / ☐ Student
Role in the project:
Affiliation:
Email address:
Name: / ☐ Student
Role in the project:
Affiliation:
Email address:
Statement of Conflict of Interest
ÉPTC2 (2014) defines conflict of interest as follows: Conflict of interest may be the result of activities or situations that create a real, potential or apparent conflict between the duties or responsibilities of a person or institution with respect to research activities, personal interest, institutional interests or other. It may be related to, among others, business interests, market or financial interests specific to the institution or individuals involved, or to their family members, friends or professional relationships, current, potential or past.
☐ The members of the research team declare that they have NO CONFLICT OF INTEREST relating to this project.
☐ The members of the research team declare that they HAVE A CONFLICT OF INTEREST (real, potential or apparent) relating to this project.
If you have declared that you HAVE A CONFLICT OF INTEREST, please specify:
Had you completed a Conflict of Interest Form? / ☐ Yes / ☐ No
Date of a Conflict of Interest Form : Click here to enter date
Project funding information
☐ Obtained / ☐ Pending / ☐ No Funding
Name of funding agency:
Name of the funding program:
Had you completed a Statement of Ethical Responsibility? / ☐ Yes / ☐ No
Research project description
Description of the project and its objectives. (1/2 page)
Position the project with respect to scientific literature and specify the motivation of the study.
(1 to 2 pages)
Methodology: Describe the methods and procedures that you will use to collect data and answer the research questions. (1 to 2 pages)
Describe your data analysis methods. (1 page)
Describe the expected research contributions. (1 page)
References (1 to 2 pages)
Recruitment of participants
☐ Adult participants / ☐ Adult participants (incapacitated) / ☐ Child participants / ☐ Other
(Please note that ÉTS’s Research Ethics Committee is not designated by the Ministry of Health and Social Services (MSSS). It does not examine research projects that pose a serious risk to the health of minors or adults who are incapacitated).
Who will be recruited? Describe the eligibility criteria for participants invited to take part in the research project.
Number of expected participants:
Why this number?
Do you have exclusion criteria for participating in this research project?
☐ Yes ☐ No
If Yes, please specify the exclusion criteria and the selection process.
Who will be responsible for recruitment?
Are there supervisory or trust-based relationships between the recruiters and participants?
☐ Yes ☐ No
If Yes, please describe the relationship and the steps taken to avoid coercion.
Describe the recruitment process.
Terms of participation
Describe what will be asked of participants. Indicate the frequency of visits and the duration of each activity. Please attach any questionnaires, surveys, interview guides, etc.
The following documents are attached:
Describe the timeframe for data collection (e.g. depending on participant availability, working hours, etc.)
Where will data collection be carried out?
Will participants be in direct contact with scientific equipment?
☐ Yes ☐ No
If Yes, provide a description of the equipment and how it will be used.
Will the project include recordings?
☐ Audio
☐ Video
☐ Photo
For any checked options, please describe: What you will do, what activities will be recorded, how you will protect participant confidentiality and who will have access to the recordings.
If you plan on using these recordings in presentations, conferences, etc., you must inform participants and obtain their authorization by having them complete and sign an Information and Consent Form.
Will participants receive financial compensation?
☐ Yes ☐ No
If Yes, please provide details. Please note that since participation in the research project is voluntary, participants are free to terminate their participation at any time without penalty. ÉTS’s Research Ethics Committee requires that any participant who decides to withdraw from a research project after it has already begun still be eligible for any financial compensation offered. If this is not the case, the Research Ethics Committee must be informed of the reason why.
Risk assessment
Which risks may participants be exposed to?
Physical injury (e.g., fall, pain) / ☐ Yes / ☐ No
Physical discomfort (e.g., fatigue, weakness, nausea) / ☐ Yes / ☐ No
Psychological or emotional damage / ☐ Yes / ☐ No
Psychological or emotional discomfort (e.g., stress, anxiety) / ☐ Yes / ☐ No
Legal implications (e.g., risk of being sued) / ☐ Yes / ☐ No
Social impact (e.g., marginalization) / ☐ Yes / ☐ No
Economic disadvantages (e.g., costs incurred due to participation) / ☐ Yes / ☐ No
Other / ☐ Yes / ☐ No
If Yes, please explain the risks and the steps taken to mitigate them.
Benefits
Describe how your research project will benefit participants.
Describe how your research project will benefit society.
Participant privacy
The primary privacy concerns relate to protecting information that could be used to identify a specific participant. Anonymous data collection is the safest way to protect the identity of participants. Data that could identify participants requires greater protection, such as anonymization or the use of pseudonyms or code when processing or transmitting data. It is important to have special protection to protect the identity of participants, especially in small groups where unintended identification associated with the combination of identifiers (date of birth, place of residence, etc.) is possible.
Will direct identifiers about participants (name, address, social insurance number, date of birth, personal characteristics, etc.) be collected?
☐ Yes ☐ No
If Yes, describe how the identity of participants will be protected. If you plan on using pseudonyms or code instead of the participants’ real names, describe who will have access to the pseudonym or code lists linking the data to the identities of the participants.
Under what conditions, if any, will it be impossible to protect the identity of participants (e.g., participants elect to identify themselves, members of discussion groups, etc.)?
☐ Yes ☐ No
If Yes, please describe these conditions and how participant identities will be used.
When the time comes to present the results of the study, will the participants be cited?
☐ Yes ☐ No
If Yes, please describe how you will remove or modify any descriptive information to ensure that citations do not reveal the identity of the participant. If the citations will mention the identity of the participant, please explain why and ensure this information is included on the Information and Consent Form.
If participants are cited, will they have the opportunity to review their transcribed citations?
☐ Yes ☐ No ☐ Participants will not be cited
If Yes, please explain the process by which participants can access their transcribed citations. If these will be sent by email, describe the security measures you will use (e.g., encryption). If no security measures are foreseen, you must inform participants of the security risks in the Information and Consent Form.
Data confidentiality
The duty of confidentiality includes the obligation to protect data against unauthorized access, use, disclosure and unauthorized modification, loss and theft. Researchers must be able to provide details to ÉTS’s Research Ethics Committee on the proposed information protection measures used throughout the data life cycle (collection, use, disclosure, storage, destruction).
Who will have access to collected data?
☐ Principal researcher
☐ Student(s)
☐ Research staff
☐ Collaborators
☐ Other
Please specify:
Describe the physical and technical protection measures that you will use to store your data safely for the duration of the research project (until the data is destroyed).
Physical security measures include locked filing cabinets, storage of research computers away from public places, etc. Administrative security measures include the development and application of organizational rules on who has access to the personal information of the participants in the research project. Technical security measures include the use of passwords, firewalls, antiviruses, encryption, etc.
Specify how long the data will be retained.
The opinion of the Research Ethics Committee is that data should be kept for 10 years following the conclusion of the research project. However, you may choose a different time period, depending on your needs.
Will you use the Archiving Department’s services to store the data collected during the research project?
☐ Yes ☐ No
If not, please describe how and where data collected during the research project will be stored.
ÉTS Archiving Department safely stores research data free of charge for internal projects. Moreover, data conservation rules may be applied so that data is automatically destroyed at the end of the specified data retention period.
Describe all data destruction methods to be used at the end of the data retention period.
Free and informed consent
Free and informed consent means that people agree to participate voluntarily in the research project and each participant understands, where possible, the purpose of the research project, what is expected from them, and any potential risks and benefits.
When French-speaking and English-speaking participants are expected in the research project, ÉTS’s Research Ethics Committee requires that the forms be available in both languages to ensure the same level of understanding.
Will an Information and Consent Form will be used?
☐ Yes ☐ No
If Yes:
Is it attached to this application?
☐ Yes ☐ No
The Information and Consent Form is written in the following language:
☐ French ☐ English
☐ Other:
Note that any Information and Consent Form presented in a language other than French or English must be accompanied by an accurate translation.
Describe the procedures used to obtain the informed consent of participants.
Who will be in charge of obtaining participant consent?
☐ The person assigned to recruitment
☐ Other Please specify:
Are there supervisory or trust-based relationships between the recruiters and participants (e.g., teacher-student, family, friend, doctor-patient, employee-employer)?
☐ Yes ☐ No
If Yes, please explain.
Does the research project involve the participation of persons under the age of 18?
☐ Yes ☐ No
If Yes, please explain.
Signature
I/we, the undersigned, hereby certify that I/we:
☐ Have read the Tri-Council Policy Statement “Ethical Conduct for Research Involving Humans” (ÉPTC2 2014)
☐ Have reviewed the application and agree with the outlined research protocol
☐ Will not undertake recruitment and data collection for the purposes of this research project without final approval from ÉTS’s Research Ethics Committee
☐ Agree to inform ÉTS’s Research Ethics Committee of any changes in the research project occurring before or after final approval is obtained
☐ Have the responsibility to disclose any conflict of interest, real or apparent, to ÉTS’s Research Ethics Committee
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Name of principal researcher / Signature / Date
Signature of co-investigators (when relevant) / Click here to enter date
Name of researcher / Signature / Date
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Name of researcher / Signature / Date
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Name of researcher / Signature / Date
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Name of researcher / Signature / Date
Updated: November 25, 2016 4/12