Flowchart to Check Necessity of Ethical Examination on Experiment/Investigation
For faculty members and students to conduct safe experiment/investigation with considering the human right under“the guidelines of experiments at Future University Hakodate”, please perform self-check beforehand on the basis of
the following flow chart to check whether ethical examination is necessary/unnecessary.
Name

Student ID No.

DateQ1.

Is it an experiment in object animals other thanhuman beings?

yesnoQ2. Is it an experiment in object human beings and possibly
results in injury?

yesnoQ3. Does the experiment/investigation in object
human beings concern effects on mental/physicalhealth of human beings?

yes

noQ4. Does the experiment/investigation in object
human beings concern violation of human rights orleakage of personal information?

no

Ethical examination is not required.

yes

Take ethical examination of experiment beforehand.

Title for Research (Name of Advisor)

Note 1. After filling out the flowchart, a faculty member needs to keep it with relevant materials of the research(for 5 years) regardless of whether the necessity of ethical examination to be able to submit them as needed.
Note 2. For answering Q1-Q4, please put a check mark on □ of the “Check Items for Self-Checking Assistance”
if applicable.

If any item is unchecked, please circle “yes” to the corresponding question of Q1-Q4.

Otherwise, please circle “no” to each question of Q1-Q4.
Note 3. Moreover, please circle “yes” to the corresponding question of Q1-Q4 when any item may be applied, even
if there is no applicable item in the “Check Items for Self-Checking Assistance”.
Note 4. If an answer is “yes” to any question of Q1-Q4, please apply for ethical examination by the specified
application form and submit it to the ethics committee via email (ethic-ml@fun.ac.jp).
Check Items for Self-Checking AssistanceQ1. Is it an experiment in object animals other than human beings?
□ Animals or creatures other than human beings will not be handled and pathogens and gene manipulation will
not be performed.
Q2. Is it an experiment in object human beings and possibly results in injury?
□ High-level radioactive rays, electromagnetic waves, and electric current will not be exposed above standard
level of daily life.
□ Human being will not be restrained or isolated physically in the facility or the apparatus.
□ Medicine or device will not be inserted into the body of human being, nor blood or cellular tissue will not
be collected.
Q3. Does the experiment/investigation in object human beings concern effects on mental/physical healthof human beings?
□ Physical/mental discomfort will not be caused by stimulus providing of video/image/sound.
□ Condition or situation that cannot be occurred in normal daily life will not be occurred by wearing any
apparatus or device on the surface of body, nor injury or physical/mental discomfort will not be caused.
□ Harmful substances will not be released, nor damage to a body or structure will not be caused by physicalstimuli such as noise, vibration, strike, and pressure.
Q4. Does the experiment/investigation in object human beings concern violation of human rights orleakage of personal information?
□ Consent for participation from research subject will not be obtained beforehand, or false explanation will
not be given.
□ Research subjects will have rights to leave the experiment/investigation regardless of the reason.
□ Political/religious belief, family relationship, income situation and other personal information will not bequestioned.
□ Data will not be obtained from research subjects without permission, nor annoyance will not be caused by
the question.
□ Information including released data, papers, report will not be identifiable.
□ Obtained data will be only used within then initial purpose or the limit that research subject consented.