NOTICE OF INTENTION TO CONDUCT RESEARCH WITHIN
CAULFIELD HOSPITAL
Please submit this form at least 3-4 weeks prior to the intended date of Ethics
submission
This Notice of Intention (NOI) applies to all research projects involving the following patient
groups at Caulfield Hospital:
1. Rehabilitation, Aged and Community Care
2. Residential Aged Care
The NOI to Conduct Research at Caulfield Hospital allows the Clinical Program Director
(CPD) (RACC) and/or the Director of Nursing and Site Coordination (DON) (RAC) to assess
the resources needed to support individual research projects conducted at this site. It will be
at the discretion of the CPD and DON to endorse research projects within either program.
Submission of the NOI can be made in the first instance via the Research Coordinator –
Caulfield Hospital who will arrange for review and signing by the CPD and/or DON.
This should be done at least 3-4 weeks prior to submission for ethical review and is intended
to identify projects that may compete for similar resources and patient groups and assist in
identification of projects that may need further assistance with research design.
Please submit this NOI by email or hard copy to:
Nicole Austin – n.austin@cgmc.org.au
Clinical Innovation & Interdisciplinary Projects
Room 38, First Floor
Executive and Nursing Services
Queries: Ext: 66333
The Research Coordinator will arrange for review and signing of the NOI by the CPD and/or
DON and will return to the applicant.
For further information, please refer to the Local Guidelines Document: CAULFIELD
HOSPITAL RESEARCH GOVERNANCE_ Authorisation to Conduct Research.doc located
on the intranet.
Project Details:
Title of project/ study:
Aims of the project:
Department/Unit/s requesting:
Researcher:
Extension:
Coordinator (if applicable):
Extension:
Expected commencement date:
Expected completion date:
Anticipated submission date for ethics application? ____/____/____
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Resources Required:
Anticipated Number of Patients/Staff =
Characteristics of Patient/Staff population =
List all Individuals and Departments Involved =
List all Individuals and External Groups Involved =
NOTE: Prior to submitting this form, it is expected that discussions will have already
occurred with your Managers and HOD and that all parties are fully aware of the
intention to conduct research.
AUTHORITY TO PROCEED:
Signature of CPD (RACC) and/or the DON (RAC) required. Note: It will be at the discretion
of the CPD and DON to endorse research projects within either program. Please submit to
n.austin@cgmc.org.au who will facilitate this process.
Signature:…………………………………………………..Date:………………….......
Name:……………………………………………………....Ext:……………………….
NOTE: If there are any changes to the above project details or resources required, this NOI
will need to be revised and resubmitted. If this is done at the time of Project Submission, the
NOI can be submitted for signing at the same time.
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