DECLARATION
* Please tick this box to confirm your declaration
-*1 As the Coordinating Principal Investigator or Austin Principal Investigator, I confirm that all the information that I have provided within this report is true and correct.
-*2 This project has been conducted in accordance with the approved project description/protocol including data collection and storage, any approval conditions, and the NHMRC National Statement on Ethical Conduct in Human Research (2007, or as amended)
This is a mandatory field.
Report Details
* Chief Principal Investigator
This is a mandatory field.
* Project HREC Number
This is a mandatory field.
SSA Reference Number
Protocol Number/Short Title
(if applicable)
* Project Title
This is a mandatory field.
Date of Report
* Reporting Period date begins
This is a mandatory field.
* Reporting Period date ends
This is a mandatory field.
* Email address for study correspondence
This is a mandatory field.
* Principal Investigator email address
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1.1 Project Status
* Project Status
Not yet commenced
In progress
Closed
Suspended
Abandoned
This is a mandatory field.
* In 250 words or less, please explain the work that was completed on this project during the reporting period including if there were any publications or presentations that have arisen form this work.
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1.2 Events
Please list below any complaints, authorship disputes, safety incidents, breaches, deviations or audit findings that occurred on this project during the reporting period
* Complaints
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* Safety Issues
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* Audit Findings
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* Authorship Disputes
This is a mandatory field.
1.3 Future Activities
* Please clarify what activities are planned for the next 12 Months
This is a mandatory field.
1.4 Consumer Engagement
* Please clarify how consumers have been involved in this project including whether feedback has been received and used to undertake process improvement activities
This is a mandatory field.
1.5 Results to participants
* Please describe the timeframe used to provide results to participants
This is a mandatory field.
1.6 Compliance with Code for the Responsible Conduct of Research
* Estimate of Total Proposed Budget
This is a mandatory field.
* Budget on target
Yes
No
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* Estimate of FTE
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* FTE on target
Yes
No
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* Project Specific Authorship Policy in Place
Yes
No
This is a mandatory field.
1.7 Participant Numbers for All Sites
There is space for three (3) site reports. Contact research@austin.org.au if you have more than three sites.
Site Name (Study site one)
Target Recruitment (Study site one) number
Ongoing participants (Study site one)
Withdrawn participants (Study site one)
Is the rate of study withdrawal expected?
Yes
No
Is the rate of loss to follow up expected?
Yes
No
Site that has completed research project
If the study is closed, have participants been informed of the results within 12 months?
Yes
No
Not applicable
Site Name (Study site two)
Target Recruitment (Study site two)
Ongoing participants (Study site two)
Withdrawn participants (Study site two)
Is the rate of study withdrawal expected?
Yes
No
Is the rate of loss to follow up expected?
Yes
No
Site that has completed research project
If the study is closed, have participants been informed of the results within 12 months?
Yes
No
Not applicable
Site Name (Study site three)
Target Recruitment (Study site three)
Ongoing participants (Study site three)
Withdrawn participants (Study site three)
Is the rate of study withdrawal expected?
Yes
No
Is the rate of loss to follow up expected?
Yes
No
Site that has completed research project
If the study is closed, have participants been informed of the results within 12 months?
Yes
No
Not applicable
Other information eg updated insurance certificate
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