Department of Theatre, Film and Television

Ethics Committee

ETHICS CLEARANCE CHECKLIST

(STUDENT INDEPENDENT PROJECTS)

This form is to be used only for student independent projects conducted in the Department of Theatre, Film and Television.

Before completing this form, please consult the TFTV Ethics Guidelines, available at https://www.york.ac.uk/tftv/research/research-ethics/.

SECTION 1: PROGRAMME DETAILS

Programme of Study:

Module title:

Year of Study:

SECTION 2: STUDENT DETAILS

Student name:

Email address:

Project title:

SECTION 3: PROJECT DETAILS

Project title:

Project supervisor name:

SECTION 4: APPROVAL

Please complete this section by marking your answer to each question with an “X” in the appropriate column.

YES / NO
1 / Will the project involve any of the following:
-  Patients and Users of the NHS
-  Relatives or carers of patients and users of the NHS
-  The use of, or potential access to, NHS premises or facilities
-  NHS staff recruited as participants by virtue of their professional role
2 / Will the project involve any of the following:
-  Vulnerable participants who are unable to make their own decisions or give informed consent (e.g. people with learning disabilities; people with mental impairment due to health or lifestyle; people who are terminally ill or recently bereaved)?
-  Any persons under the age of 18?
3 / Will the project involve non-vulnerable participants to take part with informed consent, including informed consent for recording voices or images for data collection?
4 / Will the project involve deliberately misleading participants in any way?
5 / Will financial inducements other than reasonable expenses and compensation for time (e.g. chocolate, Amazon vouchers) be offered to participants?
6 / Will the project potentially involve damaging property and/or the natural environment?
7 / Will the project involve non-human animals?
8 / Could the project potentially cause physical or emotional distress to people?
9 / Is it reasonably foreseeable that the project could result in any anticipated university/institutional risk (e.g. adverse publicity, financial loss)?
10 / Is it reasonably foreseeable that the project could result in any disclosure of confidential or sensitive information (e.g. financial data; personal data; sensitive organisational information)?

If you have answered “no” to all of the above questions:

Your project does not require ethical approval by the TFTV Ethics Committee. Please complete Section 5 and submit this form to your project supervisor or module convenor, as instructed, for their sign-off in Section 6.

If you have answered “yes” to any of the above questions:

You will need to describe more fully how you plan to deal with the particular ethical issue in an ethics clearance application (either standard or full) to the TFTV Ethics Committee. Please discuss with your project supervisor or module convenor for more advice.

SECTION 5: UNDERTAKING

In submitting this application, I hereby undertake to ensure that the above named project will meet all the statements as expressed in the checklist above and that all academic work related to the production will be guided by the University’s ethical rules and regulations.

Further, I undertake to report any changes to the above as soon as is feasible to my project supervisor, module convenor and the Chair of the TFTV Ethics Committee.

A typed/digital signature can be accepted if the form is to be returned by email from the student’s University of York account.

Name of Student
Signed
Date

Please submit this form according to your instructions from your module convenor.

If you have any queries about this or any other ethical issue, please contact the Chair of the TFTV Ethics Committee at <.

SECTION 6: SECTION FOR SUPERVISOR/MODULE CONVENOR

I confirm that I have reviewed this form and have advised the student appropriately.

Name of Supervisor
Signed
Date

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