Professional Documents
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Ethical Form
Ethical Form
Note: Read this APPLICATION FORMAT completely before you start filling it. Do not
leave any items blank. If any item is not applicable to your study, write “Not Applicable” or
“NA” against that item. We request you to use the soft copy of this format and submit the
printout of a word-processed application (three hard copies and one soft copy on CD).
I. Background Information
E-mail Id :
Designation :
Academic Qualifications :
3(a) Introduction
Satisfying ever-growing energy demand in a sustainable way has become the world's
biggest challenge. — Tony Hayward
Our future clearly depends on our ability to utilize solar and other renewable
sources of energy. Expanding technologies, tax incentives, and utility companies adapting to
solar customers are all encouraging developments in the field of solar energy. Many
households have power outage during the late night period. Without light everyone have
some fear inside, mainly during the night. After doing household survey it is found that, work
rest period has to be considered during this period of the power outage. Every room should
have night lamps majorly which can be used in night. The study on ‘’Solar Night Lamp’’
helps in reducing electricity and during power outage
3(b) Review of literature
5(a) Layout of the study involving human participants / data (Please enclose a flow-chart)
Or
Inclusion Criteria:
Men
Women
Adolescence
Exclusion Criteria:
Aged people
Children
When introducing solar night lamp to the people, it will be an alternative night lamb
during night and also in case of power outage. Mainly for the low income family, it will
become very useful for their daily purposes. It is low maintenance and budget friendly.
Publications
Thesis
⬜ Project report to funding agency
⬜ Other (Please specify)
No
If yes,
11. Are you informing the study participants that the biological samples collected will
be used for the stated purpose only?
⬜ Yes No
13. What are the benefits from this study, if any, to the study volunteers?
This study will make the study volunteers to design more solar usable devices which
conserve energy and low maintenance.
14. Who will fund your project expenses? (Enclose relevant documents) NA
I/We hereby declare that I/We have completed all sections of this application and attached all
the required documents as described in the ‘Checklist of Documents to be attached with
Application for Review by IHEC’. I/We further declare that all information provided in this
application and its attachments are true to the best of my/our knowledge and belief. I/We
understand that the approval to this study will be cancelled if I/we have provided any wrong
information or withheld relevant information from this application. I/We assure that my/our
project entitled (write the title of your project) Availability and Interoperability of Solar
Night Lamp Devices in the Market and in Selected Families, if approved by the
Institutional Human Ethics Committee of Avinashilingam Institute for Home Science and
Higher Education for Women, Coimbatore, will be carried out by adhering to the plan
described in this application, and that any deviation from the same will be communicated to
the IHEC in writing. I/We understand that deviation from the study plan described in this
application without informing the IHEC shall result in the cancellation of approval.
Name(s) and Signature(s) of the Investigator(s) & Supervisor(s) involved in this project:
Investigator:
Date: 18/11/2022
Supervisor:
Date: 18/11/2022
Head of the Department:
Date: 18/11/2022
I / We (write name(s) of the investigator(s) here), Afsha H am / are carrying out a study on
the topic Availability and Interoperability of Solar Night Lamp Devices in the Market
and in Selected Families as part of my / our research project being carried out under the
aegis of the Department of Resource Management.
The justification for this study is: Introducing solar night lamp which consumes energy.
The objectives of this study are: To
Study volunteers / participants are (specify population group & age group): 18-50
We request you to kindly cooperate with us in this study. We propose collect background
information and other relevant details related to this study. We will be carrying out:
Data collected will be stored for a period of fifteen years. We will / will not use the data as
part of another study.
Will the blood sample collected be stored after study period: ⬜ Yes
⬜ No, it will be
destroyed
Will the sample collected be shared with persons from another institution: ⬜ Yes ⬜ No
Medication / supplementation given, if any, with duration, side effects, purpose, benefits:
Consent: The above information regarding the study, has been read by me/ read to me, and
has been explained to me by the investigator(s). Having understood the same, I hereby give
my consent to them to interview me, and collect biological sample _______ from me. I am
affixing my signature / left thumb impression to indicate my consent and willingness to
participate in this study (i.e., willingly abide by the project requirements)
Afsha H
Project Timeline
Sl. N
Document Yes NA*
No. o
Duly filled in application for review by the IHEC (all sections must be
1
complete)
Permission letter from the head of the institution from where data is to
4
be collected
5 Informed Consent Form in English
9 Confidentiality Statement
[Note: Please respond to all the above items in the relevant boxes. Do not leave any item
unmarked]
Appendices-I
An interview schedule to elicit information about the Solar Devices
HOUSEHOLD SURVEY
2. Age:
20-30 31-40 61 and above
41-50 51-60
3. Gender
1 2 3 4 More than 5
5. Address :
6. Type of House :
25,000
8. Have you heard about solar night lamps?
Yes No
Newspaper Showrooms
Yes No
15. During which time Power outage affects your daily life?
Yes No
17. If yes, what device will you buy? ________________
18. How much can you invest on Solar power appliances (in Rupees)?
Below Rs.2000 /- Rs. 3000/- -5,000 /-
19. For what reasons can you opt for solar energy?
21. If using solar power devices, how much cost did you save on your electricity bill?
APPENDICES – II
MARKET SURVEY
5. Address :
Yes No
7. What are the solar devices you have for your business?
Yes No
12. If yes, for what purpose you provide?
Yes No
14. Any solar night lamps available in your shop?
Yes No
Yes No
17. Cost of the application? specify_______________
CURRICULAM VITAE
Qualification :
Permanent Address :
Email id :
Contact No. :
Interior Design
Teaching experience :
Research experience :
Student project :
Publications :
Research book :
Books :
Chapter in books :
Achievements :