University of Virginia IRB for Health Sciences Research

Research Involving Students and Employees as Subjects

IRB-HSR# or UVA Study Tracking# PI: Reviewer:

Meeting Date:

Research Includes: Students Employees

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All must be checked "YES"

Yes No / Participants are assured that confidentiality will be protected and maintained.
Yes No / Participants are assured that their status (education, employment and/or promotion) will not be affected by any decision to participate or not.
Record of participation or non-participation will not be linked to academic or employment record.
Yes No / Someone other than the investigator shall obtain informed consent and collect the data when the investigator is the student’s instructor. If this is not feasible, there must be a method of obtaining consent and collecting data that does not divulge to the investigator whether or not the student agreed to participate until after final grades have been assigned for the course.
Yes No / Record of participation or non-participation will not be made available to individuals who assess the student or employee's academic or job performance.
Yes No / Participants are assured that participation is voluntary (no signs of coercion). Students must not be penalized for refusal to participate in the research.
Yes No / Reasonable levels of extra credit or rewards may be offered for participation, however, students must be informed of non-research alternatives to obtain equivalent credit or rewards.
Yes No
NA / A “student subject pool” is a recognized approach for identifying students who are generally willing to participate in research. If subjects are recruited from a pool, students must consent to participate in each individual research study, and must be free to decline participation in any available projects without penalty. Reasonable incentives may be offered for participation (extra credit or other rewards).

CONDITIONS / SUGGESTIONS:

Are there any conditions to be communicated to the principal investigator?

Yes -(Use complete sentences in the exact language to be used in correspondence to the PI to identify required conditions .Attach additional pages as necessary).

No

Are there any suggestions to be communicated to the principal investigator?

Yes -(Use complete sentences in the exact language to be used in correspondence to the PI to share suggestions. attach additional pages as necessary).

No

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Signed (Designated Reviewer) Date

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Version: 06-16-17