SISC/QSF-OIR-032

REV 001 03/14/23

ASSESSMENT FORM

RESEARCH TITLE:

COMPASSION FATIGUE AND WELL-BEING OF SELECTED FIREFIGHTERS

RESEARCHER’S INFORMATION:
SIACHUA CLOBELLE MARIE ABELLA
SURNAME FIRST NAME MIDDLE NAME
20-0110C 20-0110c@sgen.edu.ph
STUDENT NUMBER: SGEN EMAIL ADDRESS:

ADVISER: MS. DIANIA S. IMPERIO PROGRAM OF STUDY: BS PSYCHOLOGY

ADVISER (Co-Author): MS. DIANIA S. IMPERIO

CLASSIFICATION OF RESEARCH
RESEARCH TITLE:
COMPASSION FATIGUE AND WELL-BEING OF SELECTED FIREFIGHTERS

START DATE: A.Y. 2023 - 2024 END DATE: A.Y. 2023 - 2024

RESEARCH AGENDA:
How related is your proposed research study to your Research Agenda?
My research agenda is to explore the compassion fatigue and well-being of selected firefighters. This study not only
focuses on their physical and mental health but also delves into the prevalent stigma surrounding seeking mental
health support within the firefighting community, aligning with the researcher’s agenda. Furthermore, it aims to
gain valuable insights into the challenges they face and the impact on their emotional and psychological states.

RESEARCH QUESTION/S OR OBJECTIVES:

1. What is the profile of the respondents in terms of:

1.1 Demographic: Age, Civil status, Types of Firefighters

1.2 Variables: Compassion Fatigue and Well-being

2. Is there a significant relationship between compassion fatigue and the well-being of the respondents?

3. Is there a significant difference in the relationship of compassion fatigue and the respondents' well-being when
grouped according to the:

3.1 Age;

3.2 Civil Status; and

3.3 Types of Firefighters

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 ASSESSMENT FORM/CHECKLIST FOR RESEARCHER/S:
A. DESCRIPTION OF THE RESEARCH AND METHODS TO GATHER DATA:

1. Sample to include in the study (positions in the society or job roles):

The respondents of this study will consist of firefighters. Particularly the firefighters from the Bureau of Fire Protection located
in the National Capital Region (BFP-NCR), which has 3,505 firefighters as of April 2023. Numerous fire stations throughout
NCR, including regional offices, national headquarters, headquarters, fire stations, central stations, and sub-stations.

2. How will the participants be selected or recruited?

The researcher will use social media platforms like Facebook and Instagram. Because there are groups across social media
platforms that would be helpful in finding and recruiting participants. Then the researcher will utilize stratified sampling, this
will be help utilize in case of the population of firefighters from the Bureau of Fire Protection located in the National Capital
Region (BFP-NCR) that would be divided into strata based on specified demographics such as age, civil status, types of
firefighters. Once the population has been divided into strata, a simple random sample is drawn from each stratum. The
number of participants selected from each stratum can be proportional to the size of the stratum or equal across all strata,
depending on the research design.

3. Details of data collection methods (be specific as possible):

Either stratified sampling method or purposive sampling. For, purposive sampling method will be employed to select
participants for the study’s accuracy and representativeness. The selection criteria for the study will focus on various positions
and job roles within the firefighting profession. Also, the researcher will make use of Google Forms to collect the data online,
then the researcher will join groups on Facebook to get more access on the participants in data collection.

Scoring of the Data Gathered

The researcher will use Microsoft Excel (MS Excel). Once the data are collected, they will be scored or coded according to the
predetermined criteria established for each research instrument. The researchers will assign numerical values or codes to
different responses or categories based on the measurement scales. This step will ensure that the data are prepared for
further analysis and interpretation.

Analysis Phase
Once the data is gathered in Microsoft Excel (MS Excel), the researcher will organize and use it to transfer the SPSS data for
efficient and functional analysis. The gathered data will be subjected to statistical analysis using appropriate techniques in the
analysis phase. Descriptive statistics, such as frequency distribution, percentage, arithmetic mean, and standard deviation, will
be computed to summarize the data. Inferential statistical tests, such as Pearson correlation analysis, MANOVA (multivariate
analysis of variance), and T-test, will examine relationships, differences, or associations among variables (compassion fatigue
and well-being).

Review and Final Writing Phase

After analyzing the data, the researcher will review the results in detail and interpret their implications within the context of
the research objectives. The findings will be compared and contrasted with existing literature and previous studies. The
researchers will then write the final report, including an introduction, literature review, methodology, results, discussion,
conclusions, and recommendations. The report will be reviewed multiple times to ensure accuracy, coherence, and clarity
before finalizing it for dissemination.

4. If collecting data at a primary or secondary school, work premises, police stations, law courts, and others (but not
Health Services) will you obtain or have you obtained written permission from the organization before starting the
research? If ‘No’ please explain your reason.

The researcher believes that she will obtain written permission from the relevant organization, specifically the BFP prior to
commencing the research (?). The imperative nature of collecting data from this organization is integral to the research study,
ensuring formality and acknowledgement of their essential participation in the research study.

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5. If collecting data outside SISC’s campus, will a member of the school staff or a responsible adult (family member or a
friend) be made aware of the locations you intend to undertake research, dates and times, and when you are
expected to return? Please state the name and contact information of the responsible adult you are considering.

Yes, the researcher will conduct the data gathering online or through face-to-face with the participants. The researcher’s
mother, adviser and professor will be aware of the locations she intends to undertake her research which also includes the
specific dates and times. Below are the persons who to contact:

Name: Maryrose Daphne Siachua (Mother)

Contact number: 0917-719-7863
Email: jundaphne@gmail.com

Name: Ms. Diana Imperio (Research Adviser)

Email: diana _imperio@southville.edu.ph

Name: Ms. Juli-Ann Balmonte (Research Professor)

Email: juli-ann_alonso@southville.edu.ph
6. Provide details on whether your research is being funded by a third party (including if the funding has been applied
for but not yet given).

This research study is NOT being funded by a third party.

7. Will you get ethical permission in the host country if you collect data in another country? Please explain if not. Have
you identified and met all local standards for ethical approval, research governance, and data protection in that
country? Please also provide the contact information for a local person who has been chosen to handle initial
complaints so that participants can make a complaint without having to write to.

N/A

B. CONFLICT OF INTEREST
YES NO N/A
Do you have any ties to the outside organization(s) being investigated? (For example, through ✔
personal, financial, or family ties)

If yes, please provide details. (If you are employed by an external organization, please indicate if
you will receive any cash or in-kind perks or rewards from the organization in exchange for
conducting the research.)
N/A
PROTECTION OF PARTICIPANTS’ INTEREST (FOR RESEARCHER/S)

Please also provide details on the following:

a) Identities of the participants will be protected with regard to

The Data Privacy Act, R.A. No. 10173 ensures the protection of participants' identities, all data gathered will be secured and
kept private.

b) Confidentiality in respect to the data

The researcher will ensure confidentiality in respect to the participant’s data, addressing concerns related to the protection
and non-disclosure of sensitive information gathered from participants. Additionally, it mandates that the data will be
disposed of after the designated period, further safeguarding the privacy of participants.

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c) Anonymity in terms of any disclosed findings from the research procedure will protect participants from emotional
harm or upset.
N/A
d) Will the information acquired be kept safe? (Will files and data sticks, for example, be encrypted, as well as data
saved on password-protected computers?)
Yes, thespecify
Please information
when acquired will be
the original kept secure.
recording will Files and data
be erased sticksare
if you willusing
be encrypted, anddevice
a recording data saved on password-
for interviews (e.g
protected computers. Moreover, the MS Excel used in the process will have
immediately upon uploading to a secure device such as your password-protected compuan added layer of security for protection to
enhance the overall safeguarding of the acquired information that will not be viewed by others.

What precautions will you take to avoid or reduce emotional injury or upset among participants? (Including measures
signposting individuals should they become distressed later e.g. to staff welfare services).

The researcher will adhere to the guidelines set by the Psychological Association of the Philippines and Republic Act No. 10173
to safeguard the identities of respondents or participants. In prioritizing the safety of respondents, the collected data will be
maintained as confidential and anonymous, ensuring that information about one participant remains undisclosed to others
and preventing any unnecessary leaks of information.

C. FOR SENSITIVE RESEARCH

YES NO N/A
Does the research intended to include research on illegal activities? (This may include, but is not limited
✔
to, the investigation into hate crimes, theft, fraud, or harmful and illegal cultural traditions, among other
things.)

Does the research involve deception? Are the participants well informed about the study's purpose? If ✔
not, why not?

Will the research require the usage of sites that are typically blocked on university computers (for ✔
example, pornography or the websites of these banned organizations)?

Does the intended research fit into any of the following categories? If you are unsure as to whether your
✔
research will involve any of these categories you are advised to answer ‘Yes’

- Terrorism, extremism, terrorist or extremist organizations or groups, extremist ideologies,

radicalization, de-radicalization
- Is sensitive personal data, as defined by relevant Data Protection Regulations, seen, used, or
transferred as part of the research?
- Does the research involve the acquisition of security clearances (including the Official Secrets Act)

D. WEBSITE ACCESSIBILITY

YES NO N/A

Will the research require visiting websites that could be linked to radicalization or terrorist/extremist ✔
organizations or groups as part of your research?

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E. TRASMISSION AND STORAGE OF RESEARCH MATERIALS

YES NO N/A
Is any material linked to extremism or radicalization (for example, records, statements, or other papers)
✔
being downloaded and stored on a computer as part of your research?

F. ADDITIONAL QUESTIONS

YES NO N/A
1. Are you primarily looking for pregnant women to participate in the study? ✔

2. Will anyone from the following categories be taking part in the study?

2.1 Adults without the capacity to consent ✔

2.2 Those with learning disabilities ✔

2.3 Prisoners ✔

2.4 Adults at risk (If yes please give details of) ✔

o Should there be any proof of or suspicion of harm (physical, emotional, or sexual) to

adults at risk, the protection procedures you want to implement. Include a referral
protocol that spells out what to do and who to contact.
o Explain how you propose to protect the well-being of at-risk persons, particularly in
terms of ensuring that they do not feel compelled to participate in the research and
that they are able

to withdraw from the study at any time without causing harm to themselves. You
should explain how you plan to find out about that person's opinions and desires.

2.5 Young offenders (Children in conflict with the law). ✔

2.6 Those with which the researcher has a special dependant relationship (e.g. those in care homes, ✔
students, employees, colleagues)

2. 7 Children under the age of 18 ✔

o If yes, Please describe the child protection processes you plan to implement if there is
any proof or suspicion of physical, emotional, or sexual damage to a child or young
person. Include a referral protocol that spells out what to do and who to contact.
o Please describe how you intend to protect the child's or young person's well-being,
particularly in terms of ensuring that they do not feel compelled to participate in the
research and that they are able to withdraw from the study at any time without
causing harm to them.

If you have answered yes to ANY question in Section 2 please give details

o any members of staff or students who will be in contact with vulnerable adults and/or
children (under the age of 18)

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 o a copy of your most recent Disclosure and Barring Check (and also for those staff or
students named above at a)

G. CODE OF ETHICS

Which Code of Research Ethics will be adhered to during the course of your research? Psychological Association of the
Philippines (PAP) Code of Ethics will be adhered during the course of the present study.

YES NO N/A

1. I confirm that all information collected will be processed by use in accordance with SISC research policy. ✔

2. I confirm that I will follow SISC’s ethical codes of conduct for good research practice. ✔

3. I confirm that I will follow SISC’s policy on managing research data. ✔

4. I confirm that I observe the Data Privacy Act when I gather data and DPA clause is reiterated to the ✔
participants through the DPA clause in the informed consent.

SUPPORTING DOCUMENTS (All documents should have a version number and date)

Compulsory: Please tick against each one that you are submitting with the application form

Appendix A (for all applicants)

 Research Proposal (May help the supervisor understand your ethics application)
For those whose research involves human participants (Appendices B, C and D are required)
Appendix B
 Similarity Index (20% and below)

Appendix C
 Data Collection Tools (e.g. draft interview schedule and survey questionnaire)
Appendix D
 Participant Information Sheet
Appendix E
 Consent Form
Appendix F

 Risk assessment (if applicable) (e.g. If research is being conducted off university premises)

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 H. DECLARATION AND SIGNATURES

I confirm that I have read and will follow the guidelines of the Responsibilities of the Researcher in accordance to the
SISC’s policy.

I have considered my own personal safety and have done a Risk Assessment of my study based on the guidelines.

Name and Signature of the Applicant: Date:

Clobelle Marie A. Siachua

ASSESSMENT FORM AND CHECKLIST FOR INVESTIGATORS ONLY

A. PARTS OF THE RESEARCH STUDY

The research study has the following:

YES NO NA YES NO
NA
1. Background of Study 10. Methods

2. Significance of Study 11. Elements of Informed Consent

3. Rationale of Study 12. Conflict of interest

4. Literature Review 13. Vulnerable subjects involved in

study
5. Objectives of Study

14. Curriculum vitae of investigators

6. Statement of Risks of the Project

15. Project sponsor/S

7. Possible adverse effects

16. List of references

8. Statement of benefits of the
project
17. Budget

9. Recruitment of participants

B. INFORMED CONSENT FORM CHECKLIST

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 YES NO N/A
1. The Informed Consent form is written using a language (English or Filipino) that is understandable to
the study participants).

2. Contains the following elements of informed consent:

2.1. Investigative nature of the study (Number of participants in the trial).

2.3. Objective/Purpose of the Study.

2.4. The trial procedures treatments as well as the probability for random assignment of each

treatment (if applicable).

2.5. How the trial procedures will be done including all invasive procedures (if applicable).

2.6. Expected length of time a subject will be involved and the number of follow-up visits.

2.7. Direct or potential benefits from participation (if any).

2.8. Alternative course/s procedure/s of treatment that may be available.

2.9. The study's risks, discomforts, and inconvenient aspects.

2.10. Management provision for an adverse reaction.

2.11. Responsibilities of the study’s participants.

2.12. A statement stating voluntary participation in the study.

2.13. A statement stating that participants have an option to withdraw from the study.

2.14. That the participants be provided with information that may be relevant to or their willingness to

continue participating in the study.

2.15. A statement assuring confidentiality.

2.16. The circumstances/grounds for terminating the subject's participation.

2.17. If applicable, a statement or reimbursement of participants' trial-related expenses.

2.18. A statement ensuring medical care and indemnification in the event of an adverse event not

covered by a previous waiver.

2.19. Contact person in case of questions-on adverse event (contact information).

C. ISSUES ADDRESSED

YES NO N/A

1. The study design is appropriate and adheres to ethical guidelines.

2. The research questions are within ethical parameters and are clear.

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3. The recruitment process is transparent, fair, and free of duress, and data security is not breached.

4. The sample and sampling method are both acceptable and ethical.

5. Participants are fully informed about the research in writing.

6. Is participation voluntary and based on informed consent?

7. Additional interventions are available for vulnerable people to ensure informed consent (e.g. parents,

guardians, carers, advocates, etc.)

8. Participants are provided instructions on how to file a complaint.

9. SISC’s consent form template has been used.

10. Data will be securely preserved for the appropriate amount of time.

11. External host organization permission has been requested or will be sought (where applicable)

12. Confidentiality, anonymity, and privacy will all be protected.

13. Participants' potential negative outcomes are identified, and suggestions for minimizing or dealing with

them are offered.

14. The researcher's risks are recognized, and solutions to reduce or eliminate them are provided (in the

laboratory or off campus)

15. Is a formal evaluation by another ethical committee required for the operations identified? If so, which

one is it?

D. ASSESSMENT OF RISK LEVEL

Please CLICK/CHECK the box which describes the level of risk of your research study.

I determine the risk level of this application to be;

NEGLIGIBLE RISK LOW RISK MEDIUM RISK HIGH RISK

The research has no
foreseeable harm or
discomfort, and only
foreseeable risk is no more
than an inconvenience to
participants.
Example of inconvenience
may include: filling out forms,
participating in the survey, or
giving up time to participate
in research activity
The research has only one
foreseeable risk which is
discomfort. Discomfort
includes minor side effects
of medication, discomforts
related to measuring blood
pressure and anxiety
induced by an interview.
The research has an increased The research has any
potential for emotional or possibility of harm (physically
psychological discomfort due to or emotionally) greater than
either the topic being discomfort.
investigated being controversial
or connected to social stigma or
the participants themselves are
being vulnerable.

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 E. OUTCOME REVIEW

(Please check one box only)

I recommend this study is given ethical approval (no changes required).

I do not support this application (please give reasons)

I recommend that the applicant make the suggested adjustments and have the
resubmission assessed by a Reviewer or the Chair.

List of specific changes the applicant must make to obtain ethical approval.

Additional Comment (Optional):

E. COMMITTEE REVIEWERS

_________________________ _________________________

PRINTED NAME AND SIGNATURE PRINTED NAME AND SIGNATURE

Position: Position:

Date: Date:

RESEARCHER’S COPY
PARTICIPANTS’ INFORMATION AND TEMPLATE FOR INFORMED CONSENT FORM

DATA PRIVACY CLAUSE

“The information contained in these documents is confidential, privileged and only for the information of the intended
recipient and many not be used, published, or redistributed without the prior written consent of the respondents.

The opinions expressed are in good faith and while every care has been taken in preparing these documents, respondents
make no representations and give no warranties of whatever nature with respect to these documents, including but not
limited to the accuracy or completeness of any information, facts and/or opinions contained therein.”

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_______________________________________________________________________________________________

Dear Participant/s:

Good day! I am a ____________ (course/program) ________student of Southville International School and Colleges
undertaking a research-study on ____________________________(research title)________________________________.

(Please provide details on the following :)

Purpose and methodology of the study:

o What is the purpose of the study?

o What has already been done before?

o How will the current research being carried out?

o What is the type and scope of research participants' involvement?

Risks and inconveniences:

o Will there be discomforts? Are these well-explained?

o Will there be risks? Are these completely explained?

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 o Are there any other repercussions that participants should be aware of before making a decision?

Possible benefits for the participants:

o What benefits can the participants expect from the study?

Compensation:

o Is it possible to get reimbursed for travel expenses? Is there a way to get compensated for a loss of
income? Expenses for meals? Are there other financial considerations?

Insurance coverage for injury or illness:

o What will be done if a participant sustains an injury?

o Will the participant/s receive free medical treatment if they become ill or injured as a result of their
participation in the study?

Contact person/s:

o Who is the knowledgeable person about the research and rights of the participants? How can the person be
contacted?

Participants' willingness to participate voluntarily:

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 o Are the participants free from any form of coercion in taking part?

o Is it guaranteed that the participant(s) can withdraw at any time without impacting his or her treatment or
care?

o For the case of minors, the mentally impaired, or the incompetent, is there a provision for gaining informed
consent from the legal representative?

Confidentiality

o Is there a declaration that specifies the steps that will be done to safeguard and protect the participant's
records' confidentiality?

o Is/are participant/s informed of the results of the research study?

The printed name of investigator and signature (with contact numbers)

Noted by:

_________________________________ ____________________

Printed Name and Signature of Adviser/s

Date
INFORMED CONSENT FORM

DATA PRIVACY CLAUSE

“The information contained in these documents is confidential, privileged and only for the information of the intended
recipient and many not be used, published, or redistributed without the prior written consent of the respondents.

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The opinions expressed are in good faith and while every care has been taken in preparing these documents, respondents
make no representations and give no warranties of whatever nature with respect to these documents, including but not
limited to the accuracy or completeness of any information, facts and/or opinions contained therein.”

_______________________________________________________________________________________________

CONSENT FORM

I have read and comprehended the following material and have been given the opportunity to think about and ask questions
about my participation in this study. I spoke personally with the study's investigators, who addressed all of my inquiries to my
satisfaction. This Participant's Information and Informed Consent Form has been delivered to me. I hereby agree to participate
voluntarily.

_________________________________ ____________________

Printed Name and Signature of Participant Date

_________________________________ ____________________

Printed Name and Signature of Legal Guardian Date

Witness Signature

_________________________________ ____________________

Printed Name and Signature of Participant Date

Medical Clearance (if applicable/needed)

I, the undersigned, certify that, to the best of my knowledge, the participant signing this consent form has read the above
information sheet in its entirety, that it has been thoroughly explained to him/her, and that he/she is fully aware of the
nature, risks, and benefits of his/her participation in this study.

Physician's Signature:

_________________________________ ____________________

Printed Name and Signature of Physician Date

INFORMED CONSENT FORM FOR MINORS

DATA PRIVACY CLAUSE

“The information contained in these documents is confidential, privileged and only for the information of the intended
recipient and many not be used, published, or redistributed without the prior written consent of the respondents.

The opinions expressed are in good faith and while every care has been taken in preparing these documents, respondents
make no representations and give no warranties of whatever nature with respect to these documents, including but not
limited to the accuracy or completeness of any information, facts and/or opinions contained therein.”

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_______________________________________________________________________________________________

CONSENT FORM FOR MINORS

I have read and comprehended the following material and have been given the opportunity to think about and ask
questions about my participation in this study. I spoke personally with the study's investigators, who addressed all of
my inquiries to my satisfaction. This Participant's Information and Informed Consent Form has been delivered to me. I
hereby agree to participate voluntarily.

Minor-Participant's Assent: (if participants are below 18 yrs. of age)

_________________________________ ____________________

Printed Name and Signature of Minor Date

_________________________________ ____________________

Printed Name and Signature of Legal Guardian Date

Witness Signature

_________________________________ ____________________

Printed Name and Signature of Participant Date

Medical Clearance (if applicable/needed)

I, the undersigned, certify that, to the best of my knowledge, the participant signing this consent form has read the
above information sheet in its entirety, that it has been thoroughly explained to him/her, and that he/she is fully aware
of the nature, risks, and benefits of his/her participation in this study.

Physician's Signature:

_________________________________ ____________________

Printed Name and Signature of Physician Date

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