Human Research Ethics Committee
Progress Report/Request for Extension Form
Progress reports are required annually, on the anniversary of initial approval for the research, and at the
completion of research. 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.
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 2 hard 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 (samccarthy@bendigohealth.org.au)
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
A. Project Title
B. HREC Reference No
C. Date of Ethics Approval
D. Date of Ethics Expiry
E. Progress report due date
F. Progress report submission date
H. Contact Name
I. Phone Number
(03) 9999 9999
J. Address Details
K. If this is a supervised project please indicate:
1. Level of project:
Honours
Other
2. Supervisor name
3. Supervisor Position and Qualification (e.g. PhD,
M.D.)
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Masters
Please specify:
PhD
Research Progress
1. Current status of project
Has the
project
commenced?
Data
collection:
Data
analysis:
Has the
project been
completed?
Has the
completed?
project
been
discontinued?
Other (please
describe):
Yes
Date of commencement
No
Expected commencement date
not started
continuing
completed
not started
continuing
completed
Yes
Date of completion
No
Expected completion date
Yes
Date project discontinued
Provide reasons (attach further information if required)
2. Adverse event
a. Have any adverse events been reported for this
study?
Yes
No
b. If yes, have reports been forwarded to the
Committee?
Yes
No
Yes
No
a. Have any participants lodged a complaint
regarding this research?
Yes
No
b. If yes, have copies of the complaints been
forwarded to the HREC?
Yes
No
Yes
No
c. If no, why not?
d. Have any participants withdrawn from the
project?
e. If yes, please provide details.
3. Complaints
c. If no, why not?
4. Research protocol
a. Have you deviated from the research
methodology as detailed in
the original protocol or approved amendments?
b. If yes, please explain.
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5. Participant information
a. Have all research participants received and read
(or had read to
them) the required participant information?
Yes
No
b. Have all research participants (or appropriate
approved
representatives) signed consent forms?
Yes
No
c. If no, please explain.
6. Data security
a. Is the data stored securely with due regard to
privacy concerns?
Yes
No
b. If no, please explain
7. Other issues
a. Were there any other issues concerning this
project that the
HREC should be aware of?
Yes
No
b. If yes, please explain.
8. Research summary
a. Please attach a summary of research progress. This summary should be no more than one page and
should include:
i. A brief statement of the aims of the research.
ii. A brief overview of methodology including number of participants and reasons for withdrawal of participants,
if applicable.
iii. A statement of any research findings.
iv. A summary of future work to be conducted on the project, if applicable.
v. A summary of problems that have arisen during the conduct of the research, particularly those that bear on
the capacity of the project to be completed within the approved time frame.
vi. A list of publications or conference presentations of the research. The committee would appreciate a copy
of any research publications.
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9. Request for Extension
a. Do you require an extension to the current ethics
approval?
Yes
No
b. If yes, until what date?
c. For what reasons is an extension require?
Investigator Name
Signature
Date
Supervisor name (if
applicable)
Signature
Date
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