Institutional Review Board (IRB) Application Form
Lead Investigator: Brad Franz
Department: Training & HRD
Reseacher Type: ☐ Undergraduate ☒ Graduate Student
☐Faculty/Instructional Staff ☐Admin. Staff
Email: franzb4335@my.uwstout.edu
Part 1: Primary Investigator(s) Information
Have you completed the UW-Stout IRB Training? ☒Yes ☐No
Faculty Advisor (if Student Investigator): Dr. Jeanette Black
Signature of Faculty Advisor:
Dr. Jeanette Black, RN, EdD, SPHR, SHRM SCP
Additional Investigators (include emails):
(This box will expand as you type.)
Digitally signed by Dr. Jeanette Black, RN, EdD, SPHR, SHRM SCP
Date: 2021.03.10 21:37:41 -06'00'
Part 2: Project Information
2.1 Does your project meet the federal definition of research? ☒Yes ☐No
(The federal definition of research is intended to contribute to generalizable knowledge.)
2.2 Does your project meet the definition of human subjects research? ☒Yes ☐No
(The definition of human subjects research is living individual about whom an investigator, whether professional or student conducting research: (i)
obtains information or biospecimens through intervention or interaction with the individual, and uses, studies, or analyzes the information or
biospecimens; or (ii) Obtains, uses, studies, analyzes, or generates identifiable private information or identifiable biospecimens.)
2.4 Project Title: Training & HRD – Designing a PPC Organizational culture research project
2.5 Project Type (check all that apply):
☐ Not defined as research: A project
conducted using existing public
information, such as a literature review.
☒ Classroom research: A project
conducted using normal educational
practices within established or commonly
accepted educational settings.
☐ Thesis, dissertation, or Plan B project:
A project conducted for degree
completion.
☐ No human subjects: A project
conducted without obtaining information
through interactions with human subjects
or their identifiable, private information.
☐ Clinical trial: A project in which one or
more human subjects are prospectively
assigned to one or more interventions
(which may include placebo or other
control) to evaluate the effects of those
interventions on health-related biomedical
or behavioral outcomes.
☐ Archival research: A project conducted
with research gathered entirely from
archival records, such as historical
correspondence and census data.
☐ Taste/food quality evaluation or
consumer acceptance project: A project
involving consumptions of wholesome
foods with or without additives,
ingredients, or other chemicals deemed
safe by the Food and Drug Administration
and/or the U.S. Department of Agriculture.
☐ Quality improvement project: A
project conducted to bring about
immediate improvements in delivery of
system/organization performance.
☒ Survey, interview, or observation
project: A project that will primarily use
survey, interview, observation, or
diagnostic testing procedures.
2.6 Anticipated Project Dissemination:
☐ Public dissemination: The researchers intend to publish
and/or present this study outside the classroom.
☒ Not for public dissemination: The researchers do not intend to
publish and/or present this study outside of the classroom.
2.7 Desired Start Date: 4/5/2021
2.8 Sponsor(s): ☐ Federal ☐ Non-Federal ☐ UW-Stout ☐ Funding Pending ☒ Unfunded ☐ Unsure (Contact ORSP)
2.9 Description of Research (250 to 500 word summary):
The purpose of this research is to grant hands-on experience in understanding, gathering data,
Revised 7.01.19: Review with advisor and submit final version to irb@uwstout.edu
Institutional Review Board (IRB) Application Form
and designing the culture of an organization using People Process Culture principles. The
fieldwork will be in the form of 30 minute human subject interviews via Microsoft Teams to
examine and define the current organization’s cultural values as experienced and perceived by
interviewees. The research will be conducted at the corporate and branch office level of Uline
Shipping Supplies
2.10 Methodology/Procedures of Research (describe the role/activities of participants of the study):
Interviews via Microsoft Teams. Each participant will answer (10) pre-selected open-ended interview questions.
2.11 Please describe what benefits your research may have for society:
A well-developed, researched, and cited personal theory will impact how I perform in my current role as Training
Manager to bring about and advance the characteristics of a high performance organization. The people most
impacted will be the 50+ individuals within my department of operation.
Part 3: Participant / Subject Information
3.1 What is the expected number of participants or sample size?
10
3.2 What or who is your intended participant pool?
The participants will be Uline co-workers from different departments throughout the organization’s corporate office and
North American branches.
3.3 What is your relationship with participants?
Manager, Co-worker
3.4 Please identify any vulnerable populations you intend to include in your participant pool:
☐ Pregnant Women, Human Fetuses, Neonates
☐ Prisoners
☐ Economically and/or Educationally Disadvantaged
☐ Minors (Under the Age of State Majority – In WI, 18)
☐ Individuals with impaired decision-making capacity
☐ Legally Incompetent Persons
3.5 Are you recruiting participants who are not fluent in English? ☐Yes ☒No
3.5.1 If Yes, attach translation documents—including details about who will be translating the materials.
3.6 Will you be recruiting participants and including recruitment materials with protocol?
☒ Yes ☐ No
3.6.1 If Yes, how will you be recruiting participants (i.e., include text to be used to recruit participants):
I will recruit participants via personal interaction and follow up with an email using the text below.
Greetings (first name),
As discussed, I am currently enrolled in a Master’s program for Training and HR Development at the University
of Wisconsin – Stout and performing research for the final project in my People Process Culture class.
The purpose of this research is to grant hands-on experience in understanding, gathering data, and designing
the culture of an organization using People Process Culture principles. My research will be in the form of a 30minute interview via Microsoft Teams to examine and define Uline’s cultural values as you experience and
perceive them.
Participation is 100% voluntary and all obtained data and information will be kept confidential as outlined in the
attached written consent form. Please sign and return to me via interoffice envelope if you are still willing and
able to be interviewed on (date/time).
Thank you for your time and I appreciate your willingness to assist in my research.
Regards,
Revised 7.01.19: Review with advisor and submit final version to irb@uwstout.edu
Institutional Review Board (IRB) Application Form
3.7 Will your participants be paid or compensated? ☐Yes ☒No
3.7.1 If Yes, how will participants be paid or compensated for their participation? (Please be sure to review the UW-Stout
Procedures for Payment to Research Subjects.)
(This box will expand as you type.)
3.8 Does the study involve (a) deception (providing false information) or (b) incomplete disclosure (withholding
information about some or all of the research purpose or procedures) in order to maintain the scientific
integrity of the study? ☐Yes ☒No
3.8.1 If Yes, explain the rationale and plans for protecting participants (e.g., debriefing):
(This box will expand as you type.)
Part 4: Consent
4.1 How will participants consent to their participation in research? (check what applies)
☒ Acknowledgement by written
signature
☐ Acknowledgement by digital
or other legally acceptable
electronic signature
☐ Waiver of documentation
☐ Acknowledgement by click box
(e.g., on a survey)
☐ Waiver of signature (when
allowable under regulations)
☐ Acknowledgement by implied
consent
☐ Waiver of consent (when
allowable under regulations)
4.2 Summarize the process for obtaining consent:
I will disclose interview questions prior to the interview event via email. Participants will respond via email with
their acknowledgment of participation and interoffice a signed written consent form.
Part 5: Risk/Benefit Analysis and Privacy
5.1 Are there any foreseeable risks or discomforts to participants and/or groups/communities? ☐Yes ☒No
(Minimal risk means that the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves
than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests)
5.1.1 If Yes, please describe the potential risks and/or discomforts (physical, psychological, social, informational,
reputational, legal, and/or economic):
(This box will expand as you type.)
5.2. How will you protect the privacy of your research participant data (i.e., explain how private information—like personal
identifiers—will be stored, annotated, and/or kept confidential)?
Data will stored in a password protected computer at my home and office for a period of up to one year after final
data analysis. Raw data will only be accessible by the researcher and advisor. Only aggregate data will be reported.
Part 6: Checklist of Submission Documents
6.1 Checklist of Submission Documents (check all that apply).
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Institutional Review Board (IRB) Application Form
☒ Informative
Sheet/Consent Form(s):
Standard consent form(s)
should include explanation of
procedures, risks, safeguards,
freedom to withdraw,
confidentiality, offer to
answer inquiries, third party
referral for concerns, and
participant (and/or guardian)
signature.
☒ Questionnaire/Survey
Instrument: The
questionnaire/survey
instrument must be attached.
- If the survey is being
conducted verbally, a copy of
the introductory comments
and survey questions being
asked must be attached to
this form.
- If your survey includes
focus group questions, a
complete list of the questions
should be attached.
- For research using a
published/purchased
instrument, a photocopy of
the complete survey will
suffice.
☐ Completion of Human
Subjects Training: Human
subjects training must be
completed prior to submitting
this form and will be verified.
☐ Recruitment Materials:
Include materials used for
participant recruitment such
as posters, social media
announcements, outgoing
email announcements, etc.
☐ Other Forms as Needed:
Other forms may include
advertising documents,
debriefing scripts, etc.
UW-Stout Implied Consent Statement
for Research Involving Human Subjects
Consent to Participate In UW-Stout Approved Research
Project Title: Interview for Applied Research Project. Design a PPC Organizational Culture Project – People Process Culture
INMGT 616
Description: The purpose of this interview is to gather data for critical analysis for understanding and
designing a culture using people process culture principles.
Risks: You may experience some questions that are personal or upsetting. You do not need to answer them if you don’t
want to answer. There is a chance your data could be seen by someone who should not have access to it. We’re minimizing
this risk by keeping data anonymous and removing all personal identifiers.
Benefits: You may benefit by contributing to our understanding of a people process culture as well as by providing insights
that could lead to future research and organizational improvements.
Confidentiality: No identifying information will be publicized during this study. Your name and any information regarding
the study will be stored in the researcher’s computer and will be permanently deleted once the Spring Semester 2021 ends.
Revised 7.01.19: Review with advisor and submit final version to irb@uwstout.edu
Institutional Review Board (IRB) Application Form
Future Use: Any information collected for this research project will be stripped of identifiers and will not be used in other
research in the future
Time Commitment: The interview will last up to 30 minutes.
Right to Withdraw: Your participation in this study is entirely voluntary. You may choose not to participate without any
adverse consequences to you. You have the right to stop the interview at any time. However, should you choose to
participate and later wish to withdraw from the study, there is no way to identify your anonymous document after it has
been turned into the investigator. If you are participating in an anonymous online survey, once you submit your response,
the data cannot be linked to you and cannot be withdrawn.
IRB Approval: This study has been reviewed and approved by The University of Wisconsin-Stout's Institutional Review
Board (IRB). The IRB has determined that this study meets the ethical obligations required by federal law and University
policies. If you have questions or concerns regarding this study, please contact the Investigator or Advisor. If you have any
questions, concerns, or reports regarding your rights as a research subject, please contact the IRB Administrator.
IRB Administrator
Investigator: Brad Franz
Seth Langreck
815.307.5551
Office of Research and Sponsored Programs
franzb4335@my.uwstout.edu
152 Vocational Rehabilitation Bldg.
UW-Stout
Menomonie, WI 54751
715.232.2477
Advisor: Dr. Jeanette Black
langrecks@uwstout.edu
715.232.5229
blackj@uwstout.edu
Statement of Consent:
By completing the following survey, you agree to participate in the project entitled, Interview for Applied Research Project –
People Process Culture INMGT 616
_____________________________________________________
Name
Date
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Institutional Review Board (IRB) Application Form
Applied Research Questionnaire
Brad Franz – Design a PPC Organizational
Culture Project - INMGT 616 SP2021
The purpose of this interview is to gather data for critical analysis for understanding and
designing a culture using people process culture principles.
1. Describe Uline core values important to creating and sustaining an “employee
focused”/people process culture at Uline.
2.
Describe how Uline leadership champions these core values.
3.
Describe how Uline employees support these core values.
4. Describe the ways training (continuous learning) supports employee and
organization success.
5. Listed below are 8 elements central to sustaining a people process/employee
focused culture.
– Describe what this element means to Uline and how the element is put into
practice. Please provide examples.
Very
Effective
Effective
Somewhat
Effective
Not Effective
4
3
2
1
4
3
2
1
High levels of trust
4
3
2
1
Open
communication
4
3
2
1
4
3
2
1
4
3
2
1
Change
responsiveness
4
3
2
1
Organizational
resiliency
4
3
2
1
PPC Elements
Leveraging
people-first core
values
Leadership that
“walks the talk”
Aligned
operations and
work
environments
focused on human
resources
Aligned work
environments that
focus on talent
development
Comments
6.
What underlying assumptions, unspoken rules, taken-for-granted beliefs, or perceptions have you
found to be the most empowering and limiting in Uline’s culture?
7.
How does Uline expect employees to display a sense of ownership in the business?
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Institutional Review Board (IRB) Application Form
8.
Place the following components of a high-performing organization model in order of importance
as you perceive them at Uline (Most important first).
•
Shared information and open communication
•
Compelling vision
•
Ongoing learning
•
Relentless focus on customer results
•
Energizing systems and structures
•
Shared power and high involvement
9.
What are 3 unique aspects of high performance you see at Uline every day?
10.
Why do you work for Uline?
Revised 7.01.19: Review with advisor and submit final version to irb@uwstout.edu
Institutional Review Board (IRB) Application Form
Revised 7.01.19: Review with advisor and submit final version to irb@uwstout.edu