Download ETHICS CHECKLIST Instead of completing a number of ethics

ETHICS CHECKLIST
Instead of completing a number of ethics checklists even when wildlife, human
participants, etc. are not involved in the research, theses/dissertations shall include
a declaration of non-use, placed after the approval sheet.
For Thesis Proposal
DECLARATION OF NON-USE
I,
(name)
, declare that my research entitled ____________________________
will not involve human participants, wildlife and animals, nor will it involve the use
of infectious agents and toxic substances.
Name and Signature of Researcher
Confirmed by:
Name and Signature of Adviser
For Thesis
DECLARATION OF NON-USE
Upon my honor, I,
(name)
, declare that my research entitled
____________________________ did not involve human participants, wildlife and animals,
nor did it involve the use of infectious agents and toxic substances.
Name and Signature of Researcher
Confirmed by:
Name and Signature of Adviser
*In case toxic substances are used, the following checklist should be submitted for
approval during the thesis proposal, and the approved checklist should be included
in the thesis (after the declaration of non-use):
CHECKLIST FOR THE USE OF TOXIC SUBSTANCES IN RESEARCH
Research Title ________________________
Researcher ____________________________
I.
Commercial Value
The research aim to produce a product with commercial value
 Yes
II.
 No
List and amount of substances/chemical (toxic and non-toxic) that will be
used during the conduct of research
Chemical / Substance
Amount
NOTE: The proponent is required to read/ check the material safety data sheet
(MSDS) for each of the chemical. MDS is a detailed description of the chemical’s
composition and properties provided by the company where this chemical will be
purchased.
III.
Toxicity/Hazard Assessment
Chemical/Substance
1.
2.
3.
4.
5.
6.
7.
8.
9.
These chemicals are in solid form
These chemicals are in liquid form
These chemicals are in gaseous form
These chemical substances will be synthesized,
and may have potential for misuse for unethical
purposes
These toxic chemicals will be used as
components/materials to generate another
product
These toxic chemicals will be generated as byproducts of processes used in the research
These chemicals are corrosive (can injure body
tissue or corrode metals)
These chemicals are flammable (have the
potential to catch fire readily and burn in air)
These chemicals are oxidizer and reactive (can
explode or react violently with water or
atmospheric oxygen)
10.
11.
12.
13.
14.
15.
IV.
These substances are toxins (substances that
even in small amount can injure body tissues)
The substances are mutagenic/carcinogenic
(can cause mutation or cancer)
The substances are allergenic (can cause
adverse reaction to the immune system)
The substances are irritants(can cause adverse
reaction to the immune system)
The substances are neurotoxins (can induce
adverse effect on the central or peripheral
nervous system)
These chemicals have the potential risk of being
released and cause damage to the environment
(e.g. pollution)
Preparedness
YES
1.
2.
3.
4.
5.
V.
NO
I have experience in handling toxic chemicals/substances
I will be conducting the research/experiments within the
University
There is a designated and safe working area where I can perform
the research
In case of accident, the lab facility and personnel are capable of
handling the emergency
I am aware of the guidelines for the disposal of hazardous wastes
Description of the procedure to be used in handling toxic substances
Identified Ethical/Safety/Environmental
Issues
Procedures to address these issues
I declare that to my best knowledge, all statements above are true.
Name and Signature of Researcher
Reviewed by:
Name and Signature of Adviser
Protocol Approved by:
Names and Signatures of Defense Panel