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Insurance for Research Projects and Health Sciences Fieldwork

All research projects involving human subjects must be assessed against our insurance to ensure that appropriate cover is in place for the research activity or advise if appropriate insurance is not available.

Research activity requiring insurance assessment includes (but is not limited to):


Instructions:

 

RESEARCH PROJECT INSURANCE APPLICATION:

  Write your
Answers Here
                        		For Office Use Only
School and Discipline conducting Research:    
Name of Research Project:    
Contact person and number:    
Project commencement date:    
Project completion date    
Purpose of project (summary):    
Participants/Volunteers recruited from/selection process (members of general public/students/patients in hospital?):    
Total number of volunteers:    
In what countries will you be conducting your research?    
Description of research activity - invasive and non invasive (questionnaire, treatment, testing etc.)    
Does the research project involve the administration of drugs/minerals/vitamins, etc? If yes – is the drug/mineral/vitamin TGA approved?    
Is the research project sponsored by a third party? If yes, please advise by whom and attach a copy of the relevant contract or agreement.    
Is the research a Clinical Trial (see definition of Clinical Trial):    
Who will be conducting the research or administering treatment? (Students/staff/volunteers/hospital staff/medical practitioners?)     
Time spent performing actual hands on clinical work:
  • Number of hours/ Student
  • Number of hours/ Uni Staff Member
   
Potential risk to volunteer subjects involved:
  • Short term/immediate
  • Long term
    (Is there any follow-up with patients?)
    
Potential risk and/or exposure to staff involved:    
Further information and disclosures concerning insurance coverage:    
Has the project been approved by the University’s ethics committee? (Yes/No/Not required).    
Is there an agreement with any Third Party? Eg. Hospital, aged care facility, government body etc. If yes, please attach a copy of the agreement:    
Are consent forms to be completed by patients / participants:    
Have you attached relevant information sheets, consent forms and/or contracts to this application:    

 

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