A Survey Consent Form is essential for any research or data collection activity involving human participants in South Africa. This document is required to comply with the Protection of Personal Information Act (POPIA) and other relevant South African legislation, including the National Health Act for health-related research. The form should be used prior to conducting any survey, questionnaire, or research study where personal information will be collected. It provides participants with comprehensive information about the study's purpose, data collection methods, privacy protections, and their rights, while documenting their informed consent. The document is particularly crucial in ensuring ethical research practices and legal compliance in the South African context, where data protection regulations require explicit consent for personal information processing.
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1. Title and Introduction: Clear identification of the document as a Survey Consent Form and brief introduction to the research/survey purpose
2. Researcher/Organization Information: Details of the organization/individuals conducting the survey, including contact information and institutional affiliations
3. Purpose of the Survey: Clear explanation of why the survey is being conducted and how the results will be used
4. Participant Rights and Voluntary Nature: Statement of voluntary participation, right to withdraw, and explanation that there are no negative consequences for non-participation
5. Data Collection and Processing: Description of what information will be collected, how it will be collected, and how it will be processed and stored
6. Confidentiality and Privacy: Explanation of how participant privacy will be protected and data will be kept confidential in accordance with POPIA
7. Risks and Benefits: Description of any potential risks or discomforts and any benefits of participation
8. Data Retention and Destruction: Information about how long data will be kept and how it will be destroyed
9. Declaration and Signature: Formal consent statement and space for participant signature and date
1. Compensation Information: Details of any compensation or incentives offered for participation, if applicable
2. Third Party Data Sharing: Information about sharing data with third parties or other researchers, if applicable
3. International Data Transfers: Details about cross-border data transfers if data will be processed or stored outside South Africa
4. Recording Consent: Specific consent for audio/video recording if the survey includes recorded components
5. Parental/Guardian Consent: Additional consent section for surveys involving minors or individuals who cannot provide consent themselves
6. Future Research Use: Specific consent for using the data in future research projects
1. Survey Questions Overview: Summary or example of the types of questions that will be asked in the survey
2. Privacy Policy: Detailed privacy policy of the organization conducting the survey
3. Data Protection Protocol: Detailed information about data security measures and protocols
4. Contact Information Sheet: Comprehensive list of contact details for researchers, ethics committee, and data protection officer
5. Withdrawal Form: Template form for participants to request withdrawal from the study and deletion of their data
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Relevant Teams
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Research & Development
Data Protection
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Clinical Operations
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Data Analytics
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Relevant Roles
Research Director
Data Protection Officer
Research Coordinator
Market Research Analyst
Ethics Committee Member
Legal Counsel
Compliance Officer
Research Administrator
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Survey Administrator
Research Ethics Officer
Data Privacy Manager
Research Scientist
Clinical Research Coordinator
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