CONSENT FORM FOR: THE REBECCHI INDIVIDUAL SAFETY
CONSCIOUSNESS (R.I.S.C) ASSESSMENT
Invitation to be Part of a Research Study
You are invited to participate in a research study. This
form has information to help you decide if you wish to participate. Research
studies include only people who choose to take part. Your participation is
completely voluntary, and you can stop at any time.
Please email the researcher at [email protected] to ask
any questions you have about the study or this form before deciding to
participate.
Who is conducting this study?
This study is being conducted by Thomas M. Rebecchi as the
principal investigator (PI). Dr. Philip Muna is the dissertation chair for this
project and may be included at the PI’s discretion.
Why am I invited to participate in this study?
You are eligible to participate in this study if you are 18
years old or older. You should not participate if you are not at least 18 years
old.
What is the purpose of this study?
The purpose of this study is to improve an individual’s
ability to identify hazards by measuring their safety consciousness (a
combination of safety knowledge, conditional exposure, and daily observation)
and providing personalized feedback to reduce their risk of experiencing an accident
or injury.
What will I be asked to do?
If you agree to participate, you will be asked to provide
your birth date and a valid email address. You will then be asked to select an
answer for each statement in the R.I.S.C. Assessment. Upon completing the
survey portion of the R.I.S.C. Assessment, you will be asked to review the results
and feedback you receive. The R.I.S.C. Assessment will require approximately 1
hour to complete, depending on how quickly you finish the survey portion of the
Assessment.
What are the benefits of participation in the study?
By participating in this study, you will receive information
regarding where you may be at the most risk of experiencing an accident or
injury in 24 unique categories as well as practical strategies for avoiding
them. It is hoped that the information gained in this study will benefit
society by providing useful information that participants can use to avoid
experiencing an accident or injury.
What measures will be taken to ensure the confidentiality
of the data or to protect my privacy?
Research records identifying participants will be kept
confidential to the extent permitted by applicable laws and regulations and
will not be made publicly available without your permission. However, it is
possible that other people and offices responsible for making sure research is
done safely and responsibly will see your information. This includes federal
government regulatory agencies, auditing departments of Capitol Technology
University, and the Institutional Review Board (a committee that reviews and
approves human subject research studies) may inspect and/or copy study records
for quality assurance and data analysis. These records may contain private
information.
To protect your confidentiality when results of the study
are reported, no personal identifiers will be disclosed when results of the
study are disseminated.
Will I incur any costs for participating or will I be
compensated?
Participating in this study is completely voluntary. You may
choose not to take part in the study or to stop participating at any time, for
any reason, without penalty or negative consequences. There is no cost to
participate nor will you be compensated for your participation in this study.
Will the information I provide be used for anything other
than the current study?
The personal information you provide (name, email address,
and date of birth) will not be used for other research studies. The answers you
select during the R.I.S.C. Assessment will not be recorded and will not be
disclosed when the results of this study are reported.
By providing your signature, you are agreeing to participate
in this study. Make sure you understand what the study involves before you sign.
