VICTORIAN DEPARTMENT OF HUMAN SERVICES HUMAN RESEARCH ...



DENTAL HEALTH SERVICES VICTORIA HUMAN RESEARCH ETHICS COMMITTEE

RESEARCH PROJECT REPORT

Ongoing approval of research projects by the DHSV HREC is conditional upon the provision of an update report by the 1st of July each year for which the approval has been granted, or on completion of the project, whichever is earlier.

A brief summary of the project MUST be included on, or accompany, this report form.

|Project No: |

|Project Title: |

|Principal Investigator: |

|Date of Original Approval: |

|What was the anticipated date of commencement at time of approval? |

|What was the anticipated date of completion at time of approval? |

|Please place an ‘X’ in the appropriate column |Y |N |

|Has the Project Commenced? | | |

|Date of commencement: DD/MM/YYYY | | |

|(If project has been abandoned, please provide details) |

| |

|If the approval was subject to certain conditions, have these conditions been met? | | |

|(If not, please give details) |

| |

|Please indicate the stage of your data analysis: None __ / Proceeding __ / Complete __ |

|Have problems been encountered in the following areas? | | |

| | | |

|Study Design | | |

| Ethics | | |

| Recruitment of Subjects | | |

| Finance | | |

| Facilities, equipment | | |

|(If yes, please give details) |

|Has the original protocol been modified? | | |

|Have all modifications been notified to the Committee | | |

|(Please summarise any modifications to the protocol that have not been notified to the Committee) |

|Have participants withdrawn? | | |

|(If yes, please give details) |

|Are signed consent forms available for inspection? | | |

|Has data been presented at a scientific meeting? | | |

|Has a report been published in a Refereed Journal? | | |

|Has approval expired? | | |

|If Yes, do you require an extension? | | |

|Until when? DD/MM/YYYY | | |

|(Please give reasons) |

|Have there been any adverse events? | | |

|Is this the final report for this project? | | |

BRIEF SUMMARY

Give a brief statement on progress so far. Please include:

1. summary of findings to date

2. details of any publications accepted or in press

3. details of any presentations given

4. whether participants involved in the study have been informed of the results

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FINAL REPORT

|If applicable |

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I confirm that this project is being conducted as originally approved by Dental Health Services Victoria HREC (and subject to any changes subsequently approved) and that all adverse events are reported to the Committee according to the Committee’s guidelines for reporting of adverse events and the NHMRC National Statement on Ethical Conduct in Research Involving Humans (1999).

SIGNATURE ………………………………………………… DATE ………………………..

|Please send your completed report and attachments to: |

|POST |IN PERSON |

|The Secretary, Human Research Ethics Committee |HREC Secretary |

|c/- Corporate Office |Dental Health Services Victoria |

|Dental Health Services Victoria |Level 1, Corporate Office |

|GPO Box 1273L |720 Swanston Street |

|Melbourne VIC 3001 |CARLTON 3053 |

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