|
Checklist for Review and Consent Forms |
| Does the consent form . . . | Yes | No |
| 1. Include Southwestern Adventist University in the heading of the form? | ___ | ___ |
| 2. Show clear title of the research project? | ___ | ___ |
| 3. Use language that is minimally techinical and appropriate to the reader in his/her primary language? | ___ | ___ |
| 4. Describe the purpose, procedures, and duration of the study? | ___ | ___ |
| 5. State the nature and amount of risk, stress, discomfort, or invasion of privacy? | ___ | ___ |
| 6. Describe the potential benefits of the study to the subject and/or to humanity? | ___ | ___ |
| 7. Describe the voluntary nature of participation and freedom to withdraw at any time without penalty? | ___ | ___ |
| 8. State the appropriate alternative procedures that might be advantageous or available to the subject? (If applicable) | ___ | ___ |
| 9. Indicate the extent of confidentiality or anonymity that will be maintained? | ___ | ___ |
| 10. Describe additional costs, if any, to the subject as a result of participation? | ___ | ___ |
| 11. Explain whether there will be reimbursement of costs or other inducement? | ___ | ___ |
| 12. Include an injury compensation statement? (If applicable) | ___ | ___ |
| 13. Allow the opportunity for the subject to ask questions before consenting and show the name, address, position, department, and phone number whereby the investigator(s) may be contacted if subject has further questions? | ___ | ___ |
| 14. Acknowledge the subject's receipt of a copy of the consent form? | ___ | ___ |
| 15. Provide a signature and date-line for each subject, parent, or legal guardian, and investigator, as applicable? | ___ | ___ |
| 16. Aviod any implication that there is liability release for negligence or waiver of subject's legal rights? | ___ | ___ |