RESEARCH ETHICS + CONSENT + PRIVACY RECORD

Research/pilot:
Owner:
Date:

PARTICIPANTS / DATA SUBJECTS
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PURPOSE
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WHAT DATA IS COLLECTED?
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SENSITIVE DATA?
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CONSENT TEXT / METHOD
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VOLUNTARY?
[ ] yes
[ ] no / explain

WITHDRAWAL PROCESS
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MINIMUM NECESSARY DATA
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RETENTION
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ACCESS
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DELETION
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ANONYMIZATION / PSEUDONYMIZATION
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RISK
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BENEFIT CLAIM
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PROFESSIONAL / ETHICS REVIEW NEEDED?
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APPROVAL EVIDENCE
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Do not write “IRB/ethics approved” from a plan or timeline.
Primary approval evidence is required for that claim.
