The following clauses are not applicable to this investigation (explain below the reasons for these exclusions). NOTE The above guidelines do not, in any way, absolve any investigator from any special issues of consent. This must be considered carefully including issues of privacy of health information. Refer to: for additional information INVESTIGATOR SIGNATURE AND DECLARATION The information supplied in this application is a true and accurate account of the project and is provided with sufficient clarity to enable review. I agree to conduct the research activity and handle data confidentially in accordance with the requirements of Calvary Health Care Adelaide (CHCA), the National Statement on Ethical Conduct in Human Research 2007; the Australian Code for the Responsible Conduct of Research (2007); the Code of Ethical Standards for Catholic Health and Aged Care Services in Australia (2001), and LCM Health Care national policy no 5.2.1 Ethical research and reporting requirements. I have read the application and confirm that this project: has been developed and will be conducted in accordance with relevant Calvary Health Care Adelaide standards, policies and codes of practice; has research merit; has adequate resources and appropriate leadership/supervision. I will only commence this research project after obtaining approval from the CHCA HREC and authorisation from the site CEO. Print Name: _______________________ (Principal Investigator) Signed: Dated: / / _______________________ (Principal Investigator) dd/mm/yyyy APPENDIX 1 - ESSENTIAL DOCUMENTS CHECKLIST PLEASE REVIEW THE CHECKLIST AND ENSURE THAT ALL ESSENTIAL DOCUMENTS ACCOMPANY YOUR SUBMISSION
The following clauses are not applicable to this investigation (explain below the reasons for these exclusions). NOTE The above guidelines do not, in any way, absolve any investigator from any special issues of consent. This must be considered carefully including issues of privacy of health information. Refer to: for additional information INVESTIGATOR SIGNATURE AND DECLARATION The information supplied in this application is a true and accurate account of the project and is provided with sufficient clarity to enable review. I agree to conduct the research activity and handle data confidentially in accordance with the requirements of Calvary Health Care Adelaide (CHCA), the National Statement on Ethical Conduct in Human Research 2007; the Australian Code for the Responsible Conduct of Research (2007); the Code of Ethical Standards for Catholic Health and Aged Care Services in Australia (2001), and LCM Health Care national policy no 5.2.1 Ethical research and reporting requirements. I have read the application and confirm that this project: has been developed and will be conducted in accordance with relevant Calvary Health Care Adelaide standards, policies and codes of practice; has research merit; has adequate resources and appropriate leadership/supervision. I will only commence this research project after obtaining approval from the CHCA HREC and authorisation from the site CEO. Print Name: _______________________ (Principal Investigator) Signed: _______________________ Dated: / / (Principal Investigator) dd/mm/yyyy APPENDIX 1 - ESSENTIAL DOCUMENTS CHECKLIST PLEASE REVIEW THE CHECKLIST AND ENSURE THAT ALL ESSENTIAL DOCUMENTS ACCOMPANY YOUR SUBMISSION
CHCA-HREC-Submission-and-Declaration.docx