ECT/HCI 441
Informed Consent
|
Here's a document that was sent to me along with a questionnaire. Notice that
this one involves an anonymous survey, which is different from the instrument
that what you will be using. Edit the form to suit your circumstances. --rjw
A second example of an informed consent document is located at IT.htm
Informed Consent Information
The study in which you are being asked to take part is
on the topic of XXXXXXX. It is being conducted by YYYYYY. The general purpose of
this study is ZZZZZZZ. Please be informed that, because this study is both
anonymous and confidential, you will not be asked to return a signed informated
consent form along with your questionnaire, as is normally required in studies
of this type. Instead, return of your completed questionnaire will be taken as
indication of your informed consent.
Please also be informed that:
- Your participation in the study is fully volunatry. You have the right not
to participate, and you will not be penalized for this in any way.
- All information you provide in this study is anonymous, and will be kept
strictly confidental. Any report of the study will not identify you personally
in any way.
- At the completion of the study, you will be given a thorough explanation
of the research techniques, possibile publication, and scientific impact of
the study, if you request it from the researcher AAAAAAAAAAAAAAAAA. Because
neither your name nor any other identifying information appear on your
questionnaire, xxx will not be able to send you this information automatically
upon receipt of your questionnaire.
- Although the length of time it takes different people to fill out the
questionnaire will vary depending on the different experiences they have had
in the workplace, for most people it should not take more than 15-20 minutes
to complete. You don't have to complete the questionnaire all in one sitting.
- By returning your questionnaire, you certify that you are 18 years of age
or older.
If you have any questions, please feel free to ask them. If
you desire more information in the future regarding your participation in the
study, feel free to contact the experimenter at BBBBBBBBBBBBBBB, the chair of
the dissertation committee XXXXXXX, or the chair on the Committee of the Use of
Human Subjects, CCCCCCCCCCC.
By returning your questionnaire, you indicate that you have read the
information provided above, and that you agree to participate in this study.
Please keep this document for your records.
| Name |
__________________________________________________ |
| Date |
__________________________________________________ |
Last updated Feb 17, 1999
R. J. Wolfe
School of
CTI