Page 1 of 2
Simon Fraser University
Participant Informed Consent Form for Interviewees Who are Employees in Organizations or
Institutions with Policies Governing Interviews about their Work
Project Information
1) Project title: “Online Dating & Sexual Etiquette Construction”
2) Researcher: Christopher Scott Bromley (Undergraduate Student), School of Communication, Simon
Fraser University, 8888 University Drive, Burnaby, B.C., V5A 1S6; emails: cbromley@sfu.ca, telephone
(personal office): (778) 686-1414
3) Goals of the study: XXX
4) Benefits of the study: XXX
5) Risks: No risks associated with the study are identified.
6) Procedure: You will be asked to answer a number of questions about your dating habits (as applicable)
in contemporary art conservation initiatives. Your name will be used. With your consent, additional
documentation related to your work may be collected (such as conservation treatment and condition
reports). You may choose not to answer the any of the questions presented. You may withdraw your
participation at anytime.
7) Complaints and concerns: You may register any complaint with the Director of the Office of Research
Ethics: Dr. Hal Weinberg; Director, Office of Research Ethics; Office of Research Ethics; Simon Fraser
University; 8888 University Drive, Multi-Tenant Facility, Burnaby, B.C. V5A 1S6; email:
hal_weinberg@sfu.ca
8) Copies of results: Final audio or video material will be posted online. Once completed, you will be given
a link to the material.
9) Copies of consent form: You will be given a copy of the consent form once signed.
For Face to Face Interviews: this will be printed and the following ending will be used:
My signature below indicates that I consent freely to participate in this research project by granting
permission to record or video tape my interview in the preparation of short videos and the part of the
website that will feature my interview and related materials. I understand that the project researcher
wishes to make an audio or audio/visual recording of me in connection with “Online Dating and Sexual
Etiquette Construction” project taking place on ________, ___ 20__
I hereby authorize the “Online Dating & Sexual Etiquette Construction” researcher to make the recording,
and authorize the researcher to use and distribute it by any means, without limitation and at her
discretion.
I release and discharge the researcher from any claim arising from the “Online Dating & Sexual Etiquette
Construction” use or distribution of the Recording.
NAME: ______________
CONTACT INFORMATION:
______________________________________________________________________________
______________________________________________________________________________
SIGNATURE: ___________________________________________________ DATE: ________
Page 2 of 2
Here is a script for starting the informed consent discussion in taped telephone
interviews: “Before we begin the interview I would like to read a statement about the project and
ask you a few questions to seek your informed consent and to ask about your institution’s policies
regarding consent…”)
In Telephone Interviews: the project information text up to point 5 will be read and taped.
Then the following script will be read and the respondent must agree before the interview begins:





Could you please say your name and give your contact information?
Do you consent freely to participate in this research project by granting permission to record or
video tape my interview in the preparation of short videos and the part of the website that will
feature my interview and related materials?
Do you understand that the project researcher (hereinafter “Online Dating & Sexual Etiquette
Construction”) wishes to make an audio or audio/visual recording of you in connection with
“Online Dating & Sexual Etiquette Construction” taking place on ________, ___ 20__?
Do you hereby authorize the “Online Dating & Sexual Etiquette Construction” researcher to make
the recording, and authorize the researcher to use and distribute it by any means, without
limitation and at her discretion?
Do you release and discharge the researcher from any claim arising from the “Online Dating &
Sexual Etiquette Construction” use or distribution of the Recording?