University of Cebu Academe

Research Ethics Committee

Submission Checklist
Form 2.1
UC-REC Code: Date Submitted:

Protocol No:

Protocol Title: “ A PHENOMENOLOGICAL STUDY ON MARITIME INSTRUCTOR’S EXPERIENCE IN NAVIGATIONAL

TECHNIQUES”
Site Address: A.C. Cortes Ave, Mandaue City, 6014 Cebu

Principal Investigator: Ybañez, Fretz A. Research Adviser: Ms. Michelle Madonna L. Zulueta
Email Address: vmodequillo629@gmail.com Contact No: 09493345839
Campus: University of Cebu Lapu-Lapu and MAndaue Department: Marine Transportation
Version Number ICF: Version Number Protocol:
PROTOCOL INFORMATION
Target Number of Participants Target Number of Participants
(All Sites): (UC Site):
Duration of Study:
STUDY TYPE: (Mark “ “ whichever apply to the study)

Survey Social Medical Community based Individual based 󠇓Screening Observational Epidemiology
Intervention studyClinical Trial: Phase I Phase II Phase III Phase IVGenetic StudyRetrospective Prospective Others___
STUDY POPULATION:
 Healthy  Patient  Vulnerable groups, pls specify _______________
CHARACTERISTICS of PARTICIPANTS:
Age Range:  0 -17 yrs  18 - 35 yrs  36- 53 yrs > 54 yrs
Pediatric None < 1 yr  1-3 yrs  4 -14 yrs
Impaired  None
REQUESTED EXCLUSION OF PARTICIPANTS:
 None  Male  Female  Children  Other (specify)

No. Of Copies Required Document to be Submitted Date:

2 a. Letter of Intent addressed to the Chairperson with
itemized list of documents submitted in protocol package
Executive summary that follows research project
proposal format
1 b. Proof of payment of review fee
2 c. Technical approval document
2 d. Submission Checklist Form(Form 2.1)
2 e. Synopsis(Form 2.2)
For expedited review: f. Protocol Package including the following:
2 copies i. Study Protocol
ii. Informed Consent Form in at least 2 languages
For full board review: (English and Cebuano)
10 copies iii. Investigator’s Brochure
or
3 hard copies
provided soft copy is
available
g. Curriculum Vitae of the Principal Investigator and
Adviser
h. Responsible Conduct of Research (RCR) for Principal
i. Investigator and Research Adviser GCP Training
Certificate of Principal Investigator (as required)
Submitted by:

FRETZ A. YBAÑEZ
Signature over Printed Name