RPA RPA
Research Ethics and Governance Office

Forms and Templates

Human Research
For more information on submission guidelines and required documentation when submitting a new proposal, please refer to the "How to apply" page for:

1. Ethics - non-clinical trials research studies incl. low risk studies
2. Ethics - clinical trials
3. Site Specific Applications

Ethics Forms

HREA
Sample HREA for Medical Record Research (incl. Guidance Notes)
Sample Master Code Sheet and Data Collection Form
Privacy Compliance Form
Change to study personnel

Research Date Management Plan template
RDMP SLHD template

Suggested Protocol Templates
How to write a Research Protocol
• Protocol template - Retrospective Data Collection Activities Only
SPIRIT
• Clinical Trials Protocol template

Participant Information Sheet and Consent Forms
• Invitation from Medical Officer
• Information for Participants
• Participant Consent Form
• Information for Parents / Guardians
• Parent / Guardian Consent Form
• Information for Participants (Database)
• Participant Consent Form (Database)

 Participant Information Statement (Opt-Out),including Opt-Out Form 
• Information for Participants and Consent Forms (Tissue bank/Genetics)
• Case Study PIS - CF
• Expressions of Interest

Clinical Trials Only Forms and Templates
Indemnity Standard Form
Indemnity HREC Review Only
Clinical Trials Protocol template
DSMB Checklist
DSMB Sample Agenda template

Victorian Specific Module
• Western Australia Specific Module
Information for Participants and Consent Form - Self (Interventional)
Information for Participants and Consent Form - Parent and Guardian (Interventional)
Information for Participants and Consent Form - Person Responsible (Interventional)
Information for Participants and Consent Form - Self (Health and Social Science)
Information for Participants and Consent Form- Parent and Guardian (Health and Social Science)
Information for Participants and Consent Form - Person Responsible (Health and Social Science)
• Assent Form for Children Aged 10-13 years old

Research Involving Ionising Radiation
Radiation Safety Report Form

Post-Approval Amendments
Protocol Amendment Form

Research Governance Forms
Site Specific Assessment Form (NSW SSA)
RGO Annual Report (Word)
Privacy Undertaking Form
Student Code of Conduct
• NSW Health Code of Conduct
• SSA Investigator Declaration Form
• SSA Investigator Details
• SSA Investigator Details and Declaration Form
• SSA Declaration (c)
• SSA Decalartion (b)
• SSA Authorisation by General Manager
• SSA Declaration by Academic Director (CPC-RPA Clinic only)
• SSA Principal Investigator Details
• CTN Information Form

Reporting Forms
Progress Reports
• HREC Annual Progress Report (Word)

Safety Reporting and Monitoring Forms
• Significant Safety Issue (SSI) notification form
• SUSAR/USADE/URSAE reporting form

Animal Ethics

For more information on submission guidelines and required documentation when submitting a new proposal, please refer to How to apply.

• The Application Form (Version: June 2019) is available from the office. 
• Animal Incident Form
• Radiation Research Proposal for AWC
• Checklist
• Non-Human Primates Checklist
• AWC Annual/ Completion Report Form
• AWC Bi-Annual / Completion Report Form for Breeding Protocols
• AWC Bi-Annual / Completion Report Form for ANBC
• Modification: Changes to Study Staff Form
• Study Amendment Request Form

Biosafety

For information on how and when to apply and for guidelines please refer to the How to apply page.