PILAR COLLEGE OF ZAMBOANGA CITY, INC.

R. T. Lim Boulevard, Zamboanga City

Tertiary Education Department

INFORMED CONSENT FORM

Read this document carefully. Your signature is required for your participation. Your participation
in this study will greatly help the researchers in answering the research questions through your
honest response during the data gathering. Should you have any questions/clarifications regarding
this study, feel free to contact the researchers. It is important that you understand why this
research is being done and how will you be able to help in this study.

I. Title and Purpose of the Study

This study is entitled “The Safety of Nursing Students in the Implementation of the
Limited Face-to-Face in Related Learning Experience”.

This study aims to gather factual data in order to assert about the different safety measures
of the students to assure their safety who attended face-to-face class and to further know and
understand if there are changes in result of the data that will be collected.

II. Study Procedures

The participants who will voluntarily participate in the study will be asked to do the
following:

1. Answer honestly the questions in the one-on-one interview through google meet.
2. Actively participate in the online discussion and answer the questions openly as
possible.
3. Interviews will be audio/video recorded for documentation purposes only.

III. Study Related Risks

The interview does not contain any risk and forcedly joined. It is pure voluntary
participation and you may withdraw at any time. All of the information collected will be proper
safekeeping to respect the participants’ rights and remain confidential for this study.

IV. Duration

The online interviews will last for 30 minutes with a maximum of 80 minutes that depends
on the interaction of the participants and the researcher. Henceforth, the participants will have
their freedom to answer it honestly beyond in the said time.
V. Compensation

This study does not contain money compensation and any expenses in connection with the
participation of the participants. Nonetheless, simple token will be given as a sign of gratitude.

VI. Rights of the Participant

The participation of the subject will greatly help for the success of this study. However, the
participation is purely voluntary. The participant is given the following rights:

a. The right to privacy and confidentiality;

b. The right to request a copy of the answered survey questionnaire or interview
transcription;
c. The right to ask questions for clarification; and
d. The right not to proceed nor complete the data gathering process when the participant
feels uneasy;

On the other hand, the researchers respect the subject’s decision for not participating in the
study. Data collected before the participant’s withdrawal will not be included in this study and will
be deleted accordingly. However, the subject is still encouraged to participate in order to meet the
purpose of this study.

VII. Benefits

We, the researchers mean a lot for your participation for us and for our research study.
Hence, this study may benefit you as a participant in view of the fact that the results can help us
understand and enlighten you regarding the safety as a nursing student in attending the limited
face-to-face class.

VIII. Data Privacy and Confidentiality

In compliance with the Data Privacy Act of 2012, all gathered data from the participant will
be treated will utmost confidentiality to protect the participant’s/respondent’s privacy. To ensure
this, the following will be implemented:

a. Participant’s identity will be coded,

b. All documents, such as survey questionnaire, audio/video files will be secured. Only the
lead researcher and an assistant will have the authority to see the raw data.
c. All research notes, documents including the audio/video files used in gathering
participants’ data will be deleted and destroyed after the research paper is finalized and
thereafter approved.

I have read and understood the above statement. I agree to participate voluntarily in this
research without any force.
____________________________________________________ ___________________________________
Informed Consent’s Name and Signature Date (Month/Day/Year)