Fillable Consent Form Name of Principal Investigator Name of (University of Ottawa)

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Consent Form Name of Principal Investigator Name of (University of Ottawa)

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Country of origin: CANADA
File type: PDF

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Consent Form
Title of the study: …
Name of Principal Investigator Name of Supervisor (if applicable)
Affiliation (Department, Faculty, Institute) Affiliation (Department, Faculty, Institute)
Email address Email address
Telephone number (not required) Telephone number
Invitation to Participate: I am invited to participate in the abovementioned research study
conducted by (names of researchers).
Purpose of the Study: The purpose of the study is to (clearly indicate the aim of the study, its
purpose and objectives, in a language that participants are able to comprehend using a grade 8
reading level).
Participation: My participation will consist of (description of tasks that participants will have to
perform (e.g., complete online questionnaires, participate in interviews or focus groups, etc.).
During (insert type of tasks), I will be asked (include themes and/or topics that will be covered).
***Be specific (include details: # of sessions/tasks, duration of each session/task, if audio- and/or
video-recording, if participants will be reviewing transcripts, etc.).
*If audio/video-recording or photographs are optional, add a space for participants to
indicate this choice (e.g., check boxes).
Risks: My participation in this study will entail that I (e.g., volunteer personal information, discuss
sensitive topics) and this may cause me to feel (describe potential risks or inconveniences, whether
emotional, psychological, physical, social, economic or other). I have received assurance from the
researchers that every effort will be made to minimize these risks (describe what measures are
taken to minimize such risks – e.g., option to refuse to answer, option to withdraw, identities will
not be revealed, resources will be provided, etc.).
Benefits: My participation in this study will (explain how the participation will benefit the
participant, society and/or how it will contribute to the advancement of knowledge).
Confidentiality and Privacy I have received assurance from the researchers that the information
I will share will remain strictly confidential. I understand that the contents will be used only for
(purposes for which the collected data will be used) and that my identity will be protected (explain
if anonymity will be guaranteed. If anonymity cannot be protected, state this explicitly, explain the
reason why and explain the risks involved for the participant, the organization, etc.; also, explain
whether or not the identity of the participants or their organizations will be revealed in
publications).
*If participants are given the option of remaining anonymous or using their real
names/affiliations, add a space for them to indicate this choice (e.g., check boxes).
*If participants take part in a group activity/discussion, add the following sentences (as they
apply to your project): I am aware of the limits to confidentiality of participating in a group
activity. While the researchers will respect the confidentiality of participant data, I understand
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that they cannot guarantee that other members of the group will preserve the confidentiality of
the information I will share.
*If yours is a study where the protection of confidentiality may be breached because of a legal
obligation, indicate this in the consent form and explain the reason.
*If data collection is online, add the following sentence (as it applies to your project) In order
to minimize the risk of security breaches and to help ensure my confidentiality, it is
recommended that I use standard safety measures, such as signing out of my account, closing
my browser, and locking my device when I am no longer using it/when I have completed the
study.
Conservation of Data: The data collected (list the data collected, both hard copy and electronic
data; including audio/video recordings, transcripts, survey datasets, researchers’ notes, consent
forms, etc.) will be kept in a secure manner (describe how and where the data will be stored, who
will have access to it, and how long it will be conserved).
Compensation: Describe if there is compensation – include details: type (money, ISPR credit,
draw entry, gift card, gift, etc.) and specify amount/value. If I choose to withdraw from the study,
I will still receive this compensation.
*Draws: If offering a draw, legal information must be included (see:
http://www.research.uottawa.ca/ethics/draws.html)
Voluntary Participation: I am under no obligation to participate and if I choose to participate, I
can withdraw from the study at any time and/or refuse to answer any questions, without suffering
any negative consequences (you may want to go into detail if there is a perceived risk of coercion,
if the researcher is in a position of authority, for example). If I choose to withdraw, all data gathered
until the time of withdrawal will be removed from the dataset and not used in the study (if this is
not the case, explain why).
*For anonymous survey: While participants may withdraw from the study at any time, if this is
not feasible given the anonymous nature of the study, the consent form should explain that once
the survey is submitted, participants will be unable to withdraw their data from the study as the
researchers will be unable to retrace individual datasets.
*For focus groups: Given that focus group data are highly dependent on the overall group
discussion, the REB suggests that the researchers state that the data will be used should one
choose to withdraw given the collective nature of the group discussion.
If I have any questions about the study, I may contact the researcher or their supervisor. If I have
any questions regarding the ethical conduct of this study, I may contact the Office of Research
Ethics and Integrity via email (ethics@uottawa.ca) or telephone (613-562-5387).
It is recommended that I (keep/print/save) a copy of this consent form for my records.
Choose one of the options below, as it applies to your study (and modify, if necessary):
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If signed consent is sought:
Acceptance: By signing my name below, I agree to participate in this research study.
Participant's name: _______________________ Date: __________________
Participant's signature: _______________________ Date: __________________
Researcher's signature: _______________________ Date: __________________
If verbal consent is sought and/or participation is anonymous (e.g., anonymous online survey):
Acceptance: By selecting the consent statement below, I agree to participate in this research study.
Yes, I want to participate.
No, I do not want to participate.
If consent is obtained online and personal identifiers are required (e.g., survey with name/email):
Acceptance: By selecting the consent statement below, I agree to participate in this research study.
Yes, I want to participate.
(Name/Code): ____________________
Email/Telephone number: ____________________
No, I do not want to participate.
If consent is implied based on the action of a participant (e.g., anonymous paper-based survey):
Acceptance: By completing and returning the survey, I am consenting to participate in this research
study.
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Consent Form Name of Principal Investigator Name of (University of Ottawa)

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Completed 17 May 2021

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