ETHICS COVERSHEET MUP MINOR THESIS
Student Name:
Student ID:
Proposed date to begin data collection:
Project Title:
Briefly describe project, methodology, recruitment and involvement of participants: (200 Words)
DOCUMENTS
Attached
Researcher Agreement
Must be read and signed by both the responsible researcher (Supervisor) and the student researcher.
Responsibilities Checklist
This is to ensure that the researchers involved understand the ethical requirements of those
conducting research on humans - These are Australian Government requirements not University
requirements.
Risk Assessment
Provides guidance of possible risks associated with human research and an opportunity to
explain any plans in place to minimise risks.
Plain Language Statement
Using the template provided frame your research in a way that will be easily understood by any
possible research participants. A copy of the PLS should be given to all participants to keep.
Consent Form
Using the template provided fill in your projects details. This is for participants to sign and will be
retained by the responsible researcher at the end of the project and stored in a locked cabinet with
all raw data for a minimum of 5 years.
Questionnaires and Surveys
If you are planning on conducting interviews or using surveys you should include these in your application.
Overseas Statement
If you are traveling overseas or outside the state you must include a brief statement which
outlines the potential risks for the participants, the researchers involved and any plans in
place to minimise these risks.
Not Applicable
Minor Thesis ABPL90217/8
Ethics Application 1341095 Researcher Agreement
To be read and signed by the student and supervisor prior to commencing research
We have read the University’s current human ethics guidelines, and accept responsibility for the conduct of the
procedures set out in application 1341095 in accordance with the guidelines, the University’s Code of Conduct for
Research and any other condition laid down by the University of Melbourne’s Human Research Ethics Committee or the
Architecture, Building and Planning Human Ethics Advisory Group.
We have attempted to identify all risks related to the research that may arise in conducting this research and acknowledge
our obligations and the rights of the participants. We accept that our research project is one that is low to moderate risk,
as determined by consultation with ABPL90217/8 Subject Co-ordinator and Architecture, Building and Planning (ABP)
HEAG Representative. Please refer to the attached Risk Assessment.
We have the appropriate qualifications, experience and facilities to conduct the research set out in application 1341095
and to deal with any emergencies and contingencies related to the research that may arise.
If approval is granted, the project will be undertaken in strict accordance with the approved protocol and relevant laws,
regulations and guidelines.
We, the researcher(s) agree:
 To only start this research project after obtaining final approval from the Architecture, Building and Planning Human
Ethics Advisory Group, on behalf of the University Human Research Ethics Committee (HREC);
 To provide additional information as requested by the Architecture, Building and Planning Human Ethics Advisory
Group or HREC;
 To provide progress reports to the Architecture, Building and Planning Human Ethics Advisory Group for HREC annual
and final reports;
 To maintain the confidentiality of all data collected from or about project participants, and maintain security
procedures for the protection of privacy;
 To notify the HREC in writing immediately if any change to the project is proposed and await approval before
proceeding with the proposed change;
 To notify the HREC in writing immediately if any adverse event occurs after the approval of the HREC has been
obtained;
 To agree to an audit if requested by the HREC;
 To only use data collected for the study for which approval has been given;
We have read the National Statement on Ethical Conduct in Human Research and agree to comply with its provisions.
Responsible Researcher
Name
Department
Signature
Phone
Number
Staff ID
+61
Email
Address
Student Researcher
Name
Department
Signature
Phone
Number
Student ID
+61
Email
Address
7020 - Architecture, Building And Planning
ABPL90217/8: Ethics Application 1341095
Responsibilities Checklist
Student Name:
Student ID:
Supervisor Name:
Supervisors
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Supervisors are the responsible researchers for student research projects. As such, regular supervision
meetings, as well as student consultation via email (and/or telephone) should take place throughout
the duration of the project.
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In the case of students working overseas, close email contact with supervisors will be maintained and
wherever possible a local academic contact provided, with expertise in the discipline to help with any
day-to-day contingencies.
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Supervisors should retain raw data in a password protected electronic filing system for a minimum
period of five years after publication or public release of research.
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Supervisors should read and sign the Researcher Agreement
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Supervisors should retain oversight of the Risk Assessment submission
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Research may not commence until receipt of final written approval from ABP HEAG.
Students
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Provide a Plain Language Statement to participants at their level of comprehension that details the
purpose, methods, demands, risks, inconveniences, discomforts and possible outcomes of the
research. Use the template provided on ABPL90217/8 LMS.
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Provide a Consent Form: participant’s consent needs to be clearly established by using a signed
Consent Form. Use the template provided on ABPL90217/8 LMS.
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Upon request, students are required to be willing and able to supply a full copy of their thesis
(preferably as a pdf, but also potentially in hard copy) to respondents.
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Students should allow supervisors to retain all raw data that emerges from the research project.
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Students should read and sign the Researcher Agreement.
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Students should complete a Risk Assessment. Students conducting research overseas should include
an Overseas Travel Statement.
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Research may not commence until receipt of final written approval from ABP HEAG.
ABPL90217/8: Ethics Application 1341095
Risk Assessment
Student Name:
Student ID:
Assessing Participant Risk
Does the research specifically target [select as many as applicable]:
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children/legal minors (anyone under the age of 18 years)
the elderly
people from non-English speaking backgrounds
pensioners or welfare recipients, or individuals from low socioeconomic status backgrounds
anyone intellectually or mentally impaired who cannot provide consent
anyone who has a physical disability
patients or clients of professionals
anyone who is a prisoner or parolee
a ward of the state
any other person whose capacity to give informed consent may be compromised
Aboriginal and/or Torres Strait Islander people and/or communities
other collectives where a leader or council of elders may need to give consent
persons in dependent or unequal relationships
Please use the space below to elaborate on any items selected
Does the research involve [select as many as applicable]:
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observation of participants without their knowledge
covert observation
video-taping interviewees or events
access to personal and/or confidential data (including student, patient or client data) without the participant’s specific consent
administration of any stimuli, tasks, investigations or procedures which may be experienced by participants as physically or mentally
painful, stressful or unpleasant during or after the research process
performance of any acts which might diminish the self-esteem of participants or cause them to experience embarrassment, regret or
depression
research about participants involved in illegal activities
research conducted in an overseas setting
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Please use the space below to elaborate on any items selected
Assessing Researcher Risk
Please outline where research is to be conducted (including specific location and country):
If your research is to be undertaken overseas, you are required to assess the potential risk to your safety in consultation with your supervisor.
The four areas of risk which must be considered prior to conducting research overseas are:
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Ensure your fitness for travel and participation in the activity including vaccinations
Determine the safety of the method of travel to the site
Assess the risks associated with the travel destination (note that travel to a country with a DFAT travel advisory warning of
'Reconsider your need to travel' or 'Do not travel' will not be approved)
Assess the risks of data collection
Students conducting overseas research must submit an Overseas Risk Outline that addresses these risk areas and attach it to this Risk
Assessment. Students at overseas destinations in pursuance of University activities must comply immediately with any direction given in the
interests of their safety by the Dean, Faculty General Manager, Vice-Principal and Academic Registrar or other senior University Officer.
Note to researchers This is a guide only. Please use the square brackets to change this document according to the
specific nature of your research project. Please also provide details of any risks involved and the procedures in
place to minimise these.
PLAIN LANGUAGE STATEMENT:
[Dr. Jane Doe] (Supervisor)
Faculty of Architecture, Building and Planning
ph: [6546 4564]
e: [janed@unimelb.edu.au]
[Ms. Sally Smith] (Masters Student)
ph. [8344 0000]
e: [ssmith@student.unimelb.edu.au]
Project: “[Insert title here]”
Introduction
You are invited to participate in the above research project, which is being conducted by [Dr. Jane Doe]
(supervisor) and [Ms Sally Smith] (Masters Student) of the Faculty of Architecture, Building and Planning at The
University of Melbourne. This project will form part of Ms. Smith’s Masters Thesis, and has been approved by the
Human Research Ethics Committee.
What will I be asked to do?
The aim of this study is to investigate [insert aims here]. Should you agree to participate, you would be asked to
[insert participant time expectations, and methodology e.g. interview, questionnaire]. This [methodology] would
ask you to indicate your [reactions/opinion etc.] to [aspect of research topic]. [With your permission, the
interview would be audio-recorded so that we can ensure that we make an accurate record of what you say.
When the tape has been transcribed, you would be provided with a copy of the transcript, so that you can verify
that the information is correct and/or request deletions]. We estimate that the time commitment required of you
would not exceed [x minutes].
How will my confidentiality be protected?
We intend to protect your anonymity and the confidentiality of your responses to the fullest possible extent,
within the limits of the law. Your name and contact details will be kept in a password-protected computer file
separate from any data that you supply. Your details will only be able to be linked to your responses by the
researchers, [for example, in order to know where to send your interview transcript for checking]. In the final
report, you will be referred to by a pseudonym. We will remove any references to personal information that might
allow someone to guess your identity; [however, you should note that as the number of people we seek to
interview is very small, it is possible that someone may still be able to identify you.]
How will I receive feedback?
Once the Thesis arising from this research has been completed, a brief summary of the findings will be made
available by researchers upon application. A copy of the Thesis will also be available in the Faculty of
Architecture, Building and Planning Library. [It is also possible that the results will be presented at academic
conferences]. All data will be kept securely in the Faculty of Architecture, Building and Planning for five years
from the date of publication, before being destroyed.
Will participation prejudice me in any way?
Please be advised that your participation in this study is completely voluntary. Should you wish to withdraw at
any stage, or to withdraw any unprocessed data you have supplied, you are free to do so without prejudice.
Where can I get further information?
Should you require any further information, or have any concerns, please do not hesitate to contact either of the
researchers on the numbers given above. Should you have any concerns about the conduct of the project, you
are welcome to contact the Executive Officer, Human Research Ethics, The University of Melbourne, on ph: +61 3
8344 2073, or fax: +61 3 9347 6739.
How do I agree to participate?
If you would like to participate, please indicate that you have read and understood this information by signing the
accompanying consent form [and returning it in the envelope provided]. The researchers will then contact you to
arrange a mutually convenient time to [insert methodology].
HREC 1341095 Version 1
Date approved: [10/12/2013]
Note for researchers regarding alternative confidentiality arrangements
If your project falls within a field in which it is important or conventional to name the source of your information,
you may wish to alter the Plain Language Statement, for example:
In this type of project it is normal to give the names of people who have contributed information. We would like
to seek your permission to use your name in the final thesis. If you would prefer some comments to be made off
the record, you could indicate this [during the interview, or when you review the transcript of the interview]. If for
any reason you choose not to be named, we would refer to you by a pseudonym, and remove any contextual
details that might reveal your identity. We would protect your anonymity to the fullest possible extent within the
limits of the law; your name and contact details would be kept in a locked cabinet separate from the data you
supply. You should note, however, that since the number of potential interviewees is small, it might still be
possible for someone to identify you.
If you intend to use aggregate data only, you may wish to alter the Plain Language Statement, for example:
The results of this study will be reported as group data only. Your individual information will not be identifiable in
the report. To further protect your confidentiality and anonymity, we will store your name and contact details in
a separate, locked cabinet from the data you supply. All computer files will be accessible to the researchers only,
and will be password protected. You should note that these measures are only able to guarantee confidentiality
within the limits of the law.
Notes for researchers where the research involves dependent relationships
If relevant, please include a clear statement that if participants are in a dependent relationship with any of the
researchers that involvement in the project will not affect ongoing assessment/grades/management or
treatment of health
Note to researchers This is a guide only. Please use the square brackets to change this document according to the specific
nature of your research project. Please consider if all checkboxes and information provided is relevant to, and consider if
any additional information needs to be added.
CONSENT FORM:
“[Insert title here]”
[Dr. Jane Doe] (Supervisor)
Faculty of Architecture, Building and Planning
ph: [6546 4564]
e: [janed@unimelb.edu.au]
[Ms. Sally Smith] (Masters Student)
ph. [8344 0000]
e: [ssmith@student.unimelb.edu.au]
Name of participant:
1.
I consent to participate in this project, the details of which have been explained to me, and I have been
provided with a written plain language statement to keep.
2.
I understand that after I sign and return this consent form it will be retained by the researcher.
3.
I understand that my participation will involve an [interview and observation] and I agree that the
researcher may use the results as described in the Plain Language Statement.
4.
I acknowledge that:
(a) the possible effects of participating in the [interview and observation] have been explained to my
satisfaction;
(b) I have been informed that I am free to withdraw from the project at any time without explanation
or prejudice and to withdraw any unprocessed data I have provided;
(c) the project is for the purpose of research towards a Masters Thesis;
(d) I have been informed that the confidentiality of the information I provide will be safeguarded
subject to any legal requirements;
(e) I have been informed that [with my consent the interview will be audio-recorded and I understand
that audio-recordings] will be stored at University of Melbourne and will be destroyed after five years;
(f) my name will be referred to by a pseudonym in any publications arising from the research;
(g) I have been informed that a copy of the research findings will be forwarded to me upon request.
□ yes □ no
[I consent to this interview being audio-recorded]
(please tick)
I wish to receive a copy of the summary project report on research findings
□ yes □ no
(please tick)
Participant signature:
Date: 19/11/2013
Date:
HREC 1341095Version 1