FORM H DE LA SALLE UNIVERSITY – MANILA
CIVIL ENGINEERING DEPARTMENT
THSVIL1
ETHICS CLEARANCE CHECKLIST
(General)
DE LA SALLE UNIVERSITY
General Research Ethics Checklist
This checklist is to ensure that the research conducted by the faculty members and students of
De La Salle University is carried out according to the guiding principles outlined in the Code
of Research Ethics of the University. The investigator is advised to refer to the De La Salle
University Code of Research Ethics and Guide to Responsible Conduct of Research before
completing this checklist. Statements pertinent to ethical issues in research should be
addressed below. The checklist will help the researcher/s and advisers/readers/evaluators
determine whether procedures should be undertaken during the course of the research to
maintain ethical standards. The University’s Guide to the Responsible Conduct of Research
provides details on these appropriate procedures.
Researcher (Student) Details
Principal Investigators (Students) / Department (e.g. Juan De La Cruz / Civil Engineering)
1.
2.
3.
4.
Proposed Title of the Research
Term(s) and academic year in which research
is to be conducted
Other researchers involved in project including their positions (e.g., student, faculty)
1.
2.
Student Researcher Details
Course Title
Department
Thesis Adviser
Email Address
(Students)
This checklist must be completed AFTER the De La Salle University Code of Ethics has
been read and BEFORE gathering data.
Questions Yes No
1. Does your research involve human participants (this includes
new data gathered or using pre-existing data)?
If your answer is yes, please answer Checklist A (Human
Participants).
2. Does your research involve animals (non-human subjects)?
If your answer is yes, please answer Checklist B (Animal
Subjects).
3. Does your research involve Wildlife?
If your answer is yes, please answer Checklist C (Wildlife).
4. Does your research involve microorganisms that are
infectious, disease causing or harmful to health?
If your answer is yes, please answer Checklist D (Infectious
Agents).
5. Does your research involve toxic/chemicals/
substances/materials?
If your answer is yes, please answer Checklist E (Toxic
Agents).
Research with Ethical Issues to address:
If you have a YES answer to any of the above categories, you will be required to complete a
detailed checklist for that particular category. A YES answer does not mean the disapproval of
your research proposal. By providing you with a more detailed checklist, we ensure that the
ethical concerns are identified so these can be addressed in adherence to the University Code of
Ethics.
Declaration of Conflict of Interest
[ ] 1. I do not have a conflict of interest in any form (personal, financial, proprietary, or
professional) with the sponsor/grant-giving organization, the study, the
co-investigators/personnel, or the site.
[ ] 2. I do have a conflict of interest, specifically:
[ ] A. I have a personal/family or professional interest in the results of the study
(family members who are co-proponents or personnel in the study, membership in
relevant professional associations/organizations).
Please describe the personal/family or professional interest:
____________________________________________________________
________________________________________________
[ ] B. I have propriety interest vested in this proposal (with the intent to apply for
a patent, trademark, copyright, or license)
Please describe propriety interest:
____________________________________________________________
________________________________________________
[ ] C. I have significant financial interest vested in this proposal (remuneration
that exceeds P250,000.00 each year or equity interest in the form of stock, stock
options or other ownership interests).
Please describe financial interest:
______________________________________________________
Declaration
I certify that I have read and understood the De La Salle University Code for the
Responsible Conduct of Research and will abide by the ethical principles in this document.
To the best of my knowledge that my research proposal does not involve any of the above-
mentioned categories. I will submit a final report of the proposed study to the DLSU-
Research Ethics Office. I will not commence with data collection until I receive an ethics
review approval from the College Research Ethics Committee.
_____________________________________________ ________________
Name and Signature of Researchers (Students) Date
FOR GRADUATE and UNDERGRADUATE DLSU STUDENTS ONLY
I confirm that the student(s) is/are capable of undertaking this research in a safe and ethical
manner.
_____________ _____________________ __________
Adviser’s Name Signature Date
