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Informed Consent Form Draft

The document is an Informed Consent Form for a research study titled 'A Design for Resilience: Proposed Building for MDRRMO Antequera, Bohol,' conducted by a researcher from the University of Bohol. It outlines the purpose of the study, the voluntary nature of participation, confidentiality assurances, and the rights of the informant. The form includes sections for the informant's consent, the researcher's affirmation, and important considerations for ethical compliance.

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jbberon
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6 views4 pages

Informed Consent Form Draft

The document is an Informed Consent Form for a research study titled 'A Design for Resilience: Proposed Building for MDRRMO Antequera, Bohol,' conducted by a researcher from the University of Bohol. It outlines the purpose of the study, the voluntary nature of participation, confidentiality assurances, and the rights of the informant. The form includes sections for the informant's consent, the researcher's affirmation, and important considerations for ethical compliance.

Uploaded by

jbberon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Informed Consent Form (ICF)

Part 1: Letter to the Informant

[Date]

Dear [Informant Name],

My name is [Your Name/Researcher Name], and I am a researcher from the Civil Engineering Program at
the College of Engineering, Technology, Architecture, and Fine Arts of the University of Bohol. We are
conducting a study entitled "A Design for Resilience: Proposed Building for MDRRMO Antequera, Bohol."
This research is being undertaken as part of the requirements for our subject, CEP 425: CE Project 2.

This study proposes a comprehensive architectural and structural design for a resilient two-story
Municipal Disaster Risk Reduction and Management Office (MDRRMO) facility in Antequera, Bohol. This
proposed facility aims to address the gaps in the current MDRRMO setup and enhance its capacity to
effectively respond to disasters, in accordance with Republic Act 10121 (Philippine Disaster Risk
Reduction and Management Act of 2010). Your insights and expertise as [Informant's Position/Title] are
invaluable to this research.

During the interview, we will be asking you questions related to the current operations of the MDRRMO,
the challenges faced in disaster management, and your opinions on the design requirements for a new
facility. The interview is expected to last approximately [estimated time].

Please be assured that all information you provide will be treated with the utmost confidentiality. Your
name and any identifying information will be kept strictly private and will not be associated with your
responses in any written reports or publications. The data collected will be used solely for the purpose of
this research.

Your participation in this study is entirely voluntary. You have the right to decline to answer any question,
and you may withdraw from the study at any time without penalty or prejudice. Whether or not you
choose to participate will not affect your relationship with the University of Bohol or the Antequera
MDRRMO.

If you have any questions or concerns about this research, please feel free to contact me at [Your Phone
Number] or [Your Email Address]. You may also contact our research advisor, [Advisor's Name], at
[Advisor's Email Address].

Thank you for considering our request. We greatly appreciate your time and contribution to this important
study.

Sincerely,

[Your Name/Researcher Name]

[Your Title/Position]
University of Bohol

Part 2: Certificate of Consent

Study Title: “A Design for Resilience: Proposed Building for MDRRMO Antequera,
Bohol”

I, ____________________________ (Name of Informant), confirm that I have read and


understood the information provided in the Letter to the Informant regarding the
research study "A Design for Resilience: Proposed Building for MDRRMO Antequera,
Bohol."

I understand that my participation in this study is voluntary and that I am free to


withdraw at any time without penalty. I also understand that all information I provide will
be kept confidential and used solely for the purpose of this research.

I hereby consent to participate in the interview for this research study.

____________________________
Signature of Informant

____________________________
Date

____________________________
Printed Name of Informant
Part 3: Researcher's Affirmation

I, ____________________________ (Name of Researcher), certify that I have:

* Explained the purpose, procedures, potential benefits, and risks of this research
study to the informant.
* Answered all questions asked by the informant to the best of my ability.
* Ensured that the informant understands their rights, including the right to withdraw
from the study at any time without penalty.
* Obtained voluntary informed consent from the informant prior to the commencement
of the interview.

____________________________
Signature of Researcher

____________________________
Date

____________________________
Printed Name of Researcher
University of Bohol
Important Considerations:
 Adapt the content: Carefully review and adapt the bracketed information ($$...])
to accurately reflect the specifics of your study and the informant.
 Clarity: Ensure the language used is clear, simple, and easily understandable for
the intended audience.
 Ethics Review: If your university has an ethics review board, be sure to submit
these forms for their approval before commencing your interviews.
 Copies: Provide a copy of the signed consent form to the informant for their
records.
 Storage: Store the signed consent forms securely and confidentially.
Citations:
1. https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/52880789/1fbceebd-
4f1b-4d7a-a8b3-d4cc4b082337/THESIS-REVISED.docx

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