Undertakings by responsible investigators

Title of project

Responsible investigators

Name  Institution  Department	Name  Institution  Department
Name  Institution  Department	Name  Institution  Department

Institution where project will be carried out

Name of institution Head of department/section

Name

Signature

Undertakings by investigators

The responsible investigators undertake to:

1. Protect the interests and privacy of survey subjects;
2. Provide evidence of institutional ethics committee approval of project;
3. Pay all required fees in a timely manner;
4. Limit the research to that proposed in the original application (unless a further submission is made and approved);
5. Provide the Busselton Population Medical Research Foundation (BPMRF) with a copy of all additional data collected on subjects;
6. Provide the BPMRF with an annual report (in the month of the original approval) and a final report on the outcome of the research;
7. Provide to the BPMRF a copy of any proposed publication for comment before its submission for publication;
8. Return unused biological materials to the Foundation immediately as soon as the project is completed;
9. "Busselton" should be mentioned in the title and/or abstract and in the key words of all publications using Busselton data and materials;
10. Acknowledge the Busselton Population Medical Research Foundation and the Busselton community in the manner specified by the Busselton Population Medical Research Foundation in any report or publication about the research;
11. Publications and reports on projects using data/material from the 1994-95 re-survey should acknowledge The Health Promotion Foundation of Western Australia, who provided funds for the survey.

Signatures of investigators

Name			Signature		Date
Name			Signature		Date
Name			Signature		Date
Name			Signature		Date

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