Appendix N – Summary information sheet and questionnaire recording experiences of consent collection - One form to be completed per Local Authority and PCT

National Dental Epidemiology Programme Survey

5-year-old children 2011/12

Local Authority

Primary Care Trust

Name of examiner(s)

Start - finish date of examinations -

(dd/mm/yyyy – dd/mm/yyyy)

Total number of state mainstream primary schools Number of schools visited

Total number of 5-year-old children attending state mainstream primary schools

Number of children sampled

Number of children with : parental consent parental consent consent form

supplied refused not returned

Number of children with

parental consent : examined child absent child refused

In your local authority area is there an existing procedure in place for securing consent for health activities ?

Yes (there is a clear plan) / No (each school is left to make it’s own judgement)

If Yes, what is the system ?

Do all schools comply ? Yes / No

What target figure for a minimum sample were you aiming for

In the school with the lowest response rate what proportion of children had parental consent

In the school with the highest response rate what proportion of children had parental consent

What do you think are the key factors of success of gaining high levels of consent ?

What do you think are the key factors that can lead to low levels of consent ?


Appendix N cont. – Reporting of non-BASCD standard sampling methods – additional, augmented or ‘census’ samples.

Name of PCT(s) ______

Name of LA(s) ______

Was consent sought according to the National Protocol? Yes
No
If ‘no’ please explain alternative procedure used:
Discussion with The Dental Observatory may be required about this
Were additional samples taken for local purposes or ‘additional codes’ used?
Yes
No
If yes - explanation of additional samples:
A
B
C
D
E

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