INSTITUTIONAL REVIEW BOARD – CONSENT FORM

LAHORE UNIVERSITY OF MANAGEMENT SCIENCES OSP-308-04 V 2.0

IRB Consent Form

TO PARTICIPATE IN A RESEARCH STUDY
This form must be signed by all respondents and copies must be submitted to OSP after the completion of research study
Protocol Number: _______________________________ Approval Date: _______________________________________
Activity Title:

Brief Description of the Study:

Contact Details of Researcher (Principal Investigator)

Name: Occupation:
Designation: Telephone
Address: E-mail:
University Name of PI
Guidelines for Participant:
Neither your name nor information that could identify you personally will be used in the data analysis and
publication/presentation of this study. Your identity will be kept confidential.
Your participation is completely voluntary. You may refuse to participate or withdraw your consent or discontinue your
participation in the study at any time without penalty or loss of benefits or rights to which you might otherwise be entitled.
 You will be assigned a number and your name will not be recorded.
 The researchers will save the data file and/or any video or audio recordings by a number assigned to you, not by
name.
 Only members of the research group will view or listen to the data collected.
 Any recordings or files will be stored in a secured location which will only be accessed by authorized researchers
and will be destroyed upon completion of the study.
If you have any questions about this Study, you should feel free to ask them now or anytime throughout the study by
contacting the researcher on above given details.
If you believe that your rights have been violated in any way, please contact osp@lums.edu.pk.
By signing this consent form, you are indicating your consent to participate in this study.
Contact Details of Participant:

Name: Occupation:
Cell Number: Email:

Signature of Participants: _____________________________________ Date ____________________________________

Signature of PI: ______________________________________________ Date ____________________________________

First Version: July 12, 2011 Form # OSP-308-04 [ver 2.0]

Last Revision: November 12, 2014