SCIENTIFIC RESEARCH
APPLICATION
RESEARCH AND WORKPLACE INNOVATION PROGRAM
2016
Funding occupational health research, training and education
and innovative workplace solutions
CLOSING DATE
May 11, 2016
Administrative Requirements
Please use this template to complete your Scientific Research Application
Please provide the information for questions 1 and 2 below.
1. Indicate if this is an initial application or re-submission of a previous
application. Please mark the appropriate box with an X.
Initial Application
Re-submission
2. Please let us know how you became aware of the Research and
Workplace Innovation Program (RWIP) and the annual call for
applications. Please mark the appropriate box with an X.
WCB website
WCB letter
WCB email
Other WCB communications
Word of mouth
RWIP brochure
University communications or newsletters
Other, please specify
It is very important to take note of the following:
This application must be submitted electronically via email to:
Bruce M. Cielen, Manager, Research and Workplace Innovation Program at
Email: bcielen@wcb.mb.ca by May 11, 2016 4:00p.m. CST.
Applications must be in Word format.
There are six (6) parts to this application. Please ensure that you have provided
all the information required in each part before you submit your application. A
checklist to assist you is below:
CHECKLIST - Show an X for each completed section
Part 1: General Information
2.7 Knowledge Transfer & Exchange
Part 2: Research Proposal
Part 3: Management of Project
2.1 Literature review
Part 4: Risk Assessment
2.2 Relevance and Significance
Part 5: Project Budget
2.3 Research objectives
Part 6: Research Team Information
2.4 Research Design and Methodology
2.5 Data Analysis
2.6 Scope of Research
SCIENTIFIC RESEARCH APPLICATION - RWIP 2016
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PART 1: GENERAL INFORMATION
1.1 PROJECT TITLE
1.2 PRIORITY AREA: Please mark the appropriate box with an X
Managing Psychological Injuries
The Use of Social Marketing in Affecting Attitudes and Behaviour
Regarding Workplace Safety and Health
Other topics within the mandate of the RWIP
NB: The priority area in the Scientific Research Application should be the same
as the priority area selected in the Notice of Intent
1.3 PRINCIPAL APPLICANT/S
Name
Title
Host Institution
Business Mailing Address
Telephone Number
Email
Other Contact Information
Signature
Date
If there is more than one principal applicant provide information as above
1.4 CO- APPLICANT/S
Name
Title
Host Institution
Business Mailing Address
Telephone Number
Email
Other Contact Information
Signature
Date
If there is more than one co-applicant provide information as above.
SCIENTIFIC RESEARCH APPLICATION - RWIP 2016
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PROJECT TITLE:
1.5 APPROVAL BY HEAD OF ACADEMIC DEPARTMENT/RESEARCH
ORGANIZATION
Name
Title
Host Institution/Organization
Business Mailing Address
Telephone Number
Email
Other Contact information
Signature
Date
Where Applicable
1.6 INFORMATION OF FINANCIAL OFFICER WHO WILL MANAGE GRANT
FUNDS
Name
Title
Host Institution/Organization
Business Mailing Address
Telephone Number
Email
Other Contact information
Signature
Date
1.7 SUMMARY OF SCIENTIFIC RESEARCH PROPOSAL
Please provide a summary of the research proposal that includes the following:
i.
ii.
iii.
iv.
v.
A brief description of the study to include the research question, issue
or problem, how the study will address it and how the study will be
done
The relevance to the WCB and fit with the mandate of the Research and
Workplace Innovation Program
Steps to transfer research findings to end users
Funding amount requested
Duration of study
Should not exceed two (2) pages
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PROJECT TITLE:
1.8 IF THIS IS A RE-SUBMISSION OF A PROPOSAL
If this proposed study is a re-submission of an earlier one please provide a
response to the comments and critiques of the WCB. In the case of scientific
research applications, the WCB's comments would have included the evaluation
from peer reviewers. The applicant should indicate how the re-submitted
application is revised based on the feedback provided by the WCB in its letter
informing the applicant about the status of his or her previous application.
Should not exceed one page
PART 2: RESEARCH PROPOSAL
2.1
LITERATURE REVIEW OF EXISTING KNOWLEDGE
The review of existing knowledge in the proposed study area/s should at a
minimum include the following:
i.
ii.
iii.
2.2
RELEVANCE AND SIGNIFICANCE OF RESEARCH
i.
ii.
iii.
2.3
A description of leading research and data in the body of knowledge
encompassing the proposed area/s of study;
An analysis of the relative strengths, weaknesses, limitations and
gaps in knowledge relative to the proposed study area/s; and
A discussion of key completed studies and on-going research in the
Canadian context such as research by workers compensation boards,
academic institutions, research organizations and other researchers
which relate to this study.
Explain why the proposed research would be different from the
information in 2.1 above;
Identify the central issues and/or problems the proposed research
would be addressing and explain why this is important to Manitoba;
and
Describe the theoretical and practical significance of the proposed
research including a description of how the proposed study would fill
gaps in knowledge, policy, programs or practices for workers
compensation.
RESEARCH OBJECTIVES
i.
ii.
Specify clearly the objectives of the research; and
Provide the rational for the research objectives.
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PROJECT TITLE:
2.4
RESEARCH DESIGN AND METHODOLOGY
Please provide a clear explanation of the theoretical/conceptual framework
guiding the research. Your explanation should at a minimum include:
i.
ii.
iii.
iv.
Key concepts and definitions;
Rationale for selection of theoretical framework;
Research methodology; and
Sample Information: description, estimated size, etc. and sources
that will provide the basis for selection of sample.
If you plan to use proven research instruments please attach copies.
2.5
DATA ANALYSIS
i. Indicate if your study will require data from the WCB or Workplace
Safety and Health Division, Manitoba Labour and Immigration.
ii. Identify data sources;
iii. Describe the method/s and software requirements;
iv. Describe the types of data that will address research objectives and
issues; and
v. Indicate if methodology needs approval of an ethics review board and
whether the study involves any of the following:
a) Human subjects;
b) Stem cells;
c) Vertebrate animals;
d) Biological research hazards; and
e) An environmental impact or assessment.
2.6
SCOPE OF RESEARCH
i.
ii.
iii.
2.7
State what the study will address and areas that will not be covered
by study;
Explain the linkage between the scope of the study relative to the
budget request; and
Describe how the study's scope anticipates successful completion
within the proposed project's duration.
KNOWLEDGE TRANSFER and EXCHANGE (KTE)
An on-going objective of the RWIP is to ensure the resources developed and
learning gained from RWIP projects are broadly shared and used by WCB
leadership and staff, other researchers, Manitoba employers, workers and policy
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PROJECT TITLE:
makers. The KTE plan should apply the integrated KTE process to engage
stakeholders, decision-makers and knowledge users during the life of a project.
The KTE plan should also include activities to promote successful project
outcomes, best practices and research evidence into practical applications that
can be used to prevent occupational injury, illness and disease and to foster
successful rehabilitation and productive return-to-work of injured or ill workers.
More information on KTE for RWIP projects is provided in sections 5.2 and 5.3 of
the Applicant Information document.
The estimated cost for KTE should be included in the project's budget. See
Section 7.6 of the Applicant Information for more information on the budget
requirements.
PART 3: MANAGEMENT OF PROJECT
Please provide a timetable and work plan that will:
i.
ii.
iii.
iv.
Identify and describe project activities;
Specify key milestones;
Identify start and finish dates; and
Relate costs to project activities.
Please use the format below. Activities should be listed in sequence, indicating
related activities and dependencies for successful completion.
TIMETABLE OF KEY PROJECT ACTIVITIES
Specify Key Project Milestones
Start Date
Completion
Date
Estimated
Cost
Add rows as needed
Should not exceed one page
PART 4: RISK ASSESSMENT
Identify the potential risks to successful completion of the project, e.g.
cooperation from workplace parties, participation of subjects, resource
availability etc.
Use the Risk Assessment Matrix below to describe the risks and potential
solutions to mitigate the risks identified.
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PROJECT TITLE:
RISK ASSESSMENT
Describe Potential
Risk Event
Use a single row for
each potential risk
identified
Assess Risk
Likelihood
Select one
response from
the list below
for each risk
identified:
Use specific project
objectives,
milestones, activities -Very Likely
or deliverables to
-Probable
identify risk events. -Very Unlikely
Estimate Impact
Select one
response from
the list below
for each risk
identified:
Strategy/Plan to Mitigate
Risks
Describe the strategy or
plan for each risk identified
-High
-Medium
-Low
Should not exceed one page
PART 5: PROJECT BUDGET
5.1
EXPLANATION OF BUDGET AND JUSTIFICATION OF BUDGET ITEMS
Use the format below to assist you in completing the budget.
 The WCB will provide support for the direct costs of the project [including
project assistance, support for technical, professional and secretarial services,
equipment (purchase or rental), project-related travel and supplies].
 Project costs may include reasonable administrative costs, but should not
include blanket surcharges for institutional overhead, costs of salary
replacement for staff involved in project, buy-outs of teaching time or other
responsibilities of the applicant/s, co-applicant/s or the study's partners.
 Applicants must also demonstrate that the WCB grant and/or any financing
from other sources will provide adequate financial support to achieve the
objectives of the proposal.
Please take note that the WCB is GST exempt.
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PROJECT TITLE:
BUDGET ITEMS AND JUSTIFICATION1
Budget Item
Year 1
Year 2
Total
WCB $ WCB $ WCB $
Request Request Request
Justification of Funds
1 Salaries,
Benefits/Consultancy
fees2 (Specify for
each of project team)
Sub-Total
2 Material and supplies
(list each item
greater than $1,000)
Subtotal
3 Equipment
(purchase, rental,
lease)
Subtotal
4 KTE
Subtotal
5 Travel,
accommodation and
meals3
Subtotal
6 Other costs (specify
by item; for example
stipends paid to
individuals in sample
Subtotal
Total WCB Funding
Request
(sum of items 1 to 6)
Specific project costs
met by the employer
( in-kind)
Subtotal
1
Include all items essential for the conduct of the project. Provide a brief, clear justification for each
budget item and relate it to the objectives and requirements of the proposed research. The budget
quantifies the timetable and work plan in terms of personnel, materials, supplies, and other
SCIENTIFIC RESEARCH APPLICATION - RWIP 2016
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PROJECT TITLE:
requirements. Accordingly, it is essential that the link between the research proposal and the budget be
clear.
2
Applies for new staff or consultants hired to work on the project. It should not include salaries or
benefits of current employees participating or involved in the project.
3
Any cost of transportation, accommodation and meals paid according to WCB Manitoba rates. Estimate
the number of days, transportation, accommodation and meal costs by number of persons and number
of days. See Section 12 of the Applicant Information document for WCB Manitoba rates for travel,
accommodation and meals.
PART 6: RESEARCH TEAM INFORMATION
6.1.
BIOGRAPHICAL SKETCH OF PRINCIPAL APPLICANT, CO-APPLICANT/S AND
OTHER TEAM MEMBERS
Each biographical sketch:
i.
ii.
iii.
must be part of the electronic application form;
may not be longer than 5 pages; and
include the following elements:
o full name and title;
o institution or organization;
o educational background (institution, degree/diploma,
certificate/qualification conferred, year conferred, and field of
study);
o research and professional experience;
o publications, and
o funding applied for and received.
FORMAT FOR BIOGRAPHICAL SKETCH
Name, Title, Contact Information
Surname
Given Name, Initials
Title (Dr., Mr., Ms., Other)
Institution/Organization
Educational Background
Institution and location
Degree/Diploma/
Year
Certificate/Qualification
Field of study
Research and Relevant Professional Experience
In chronological order, list previous employment, experience and honours,
concluding with current position held
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PROJECT TITLE:
List all publications for the last 5 years which relate to this research proposal
Funding Applied for and Received ( over the last 5 years)
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