Disciplinary action by the SHA which may result in the suspension or revocation of my appointment and privileges, or the termination of my employment; A legal action being brought against me by the SHA or the patient affected by the breach of Confidential Information; A complaint or report about me being made to my professional licensing body by the SHA; A complaint being made to the Privacy Commissioner by the SHA; and/or A complaint to a law enforcement agency by the SHA. In addition to other remedies available, SHA will not provide any further data to the Researcher if any of the conditions set out in this Agreement have been breached and will seize the data already provided. The terms and conditions of this Agreement will be of indefinite duration. Please Note: Depending on the nature of the research project, a separate Memorandum of Understanding (MOU) between the Saskatchewan Health Authority and the Principal Investigator may be required. Signature of Principal Investigator:______________________________Date:______________________ Please complete this form and submit it electronically to the Research Approval Coordinator. The signature page can either be submitted as a scanned PDF page of a hand written signature or as a hard-copy page mailed to the Research Approval Coordinator. Research Approval Coordinator Contact Information: Research and Performance Support Room M-704, Wascana Rehabilitation Centre 2180 - 23rd Avenue Regina, SK S4S 0A5 (306) 766-0893 PART 7: ATTACHMENTS Provide a full and accurate listing of all documents submitted with this application.
Disciplinary action by the SHA which may result in the suspension or revocation of my appointment and privileges, or the termination of my employment; A legal action being brought against me by the SHA or the patient affected by the breach of Confidential Information; A complaint or report about me being made to my professional licensing body by the SHA; A complaint being made to the Privacy Commissioner by the SHA; and/or A complaint to a law enforcement agency by the SHA. In addition to other remedies available, SHA will not provide any further data to the Researcher if any of the conditions set out in this Agreement have been breached and will seize the data already provided. The terms and conditions of this Agreement will be of indefinite duration. Please Note: Depending on the nature of the research project, a separate Memorandum of Understanding (MOU) between the Saskatchewan Health Authority and the Principal Investigator may be required. Signature of Principal Investigator:______________________________Date:______________________ Please complete this form and submit it electronically to the Research Approval Coordinator. The signature page can either be submitted as a scanned PDF page of a hand written signature or as a hard-copy page mailed to the Research Approval Coordinator. Research Approval Coordinator Contact Information: Research and Performance Support Room M-704, Wascana Rehabilitation Centre 2180 - 23rd Avenue Regina, SK S4S 0A5 (306) 766-0893 PART 7: ATTACHMENTS Provide a full and accurate listing of all documents submitted with this application.