Study Task Key: The sponsor may detail in the below key the main study activities that the PI can delegate to staff at the participating organisation. The task list and delegation log are intended to be maintained as an up to date document throughout the duration of the study at the participating organisation. Screens/recruits study subjects Enter other task here Enter other task here Enter other task here Obtains Informed Consent Enter other task here Enter other task here Enter other task here Confirms eligibility (Inclusion/Exclusion) Enter other task here Enter other task here Enter other task here Enter other task here Enter other task here Enter other task here other task here Enter other task here Enter other task here Enter other task here Enter other task here Name Signature2 Initials Study Role Study Task(s) (Select from key) Start of task(s) (dd/mmm/yy) PI Initials End of task(s) (dd/mmm/yy) PI Initials 2My signature confirms/acknowledges that I accept the assigned study task/s and that: I am not involved in any regulatory or misconduct litigation or investigation by any regulatory authority, and no data produced by me in any previous clinical Study has been rejected because of concerns as to its accuracy or because it was generated by fraud.
I am willing for my response, and quotes used from it, to be used in non-identifiable form in any consultation report and any future HRA publications: I am willing for my response, and quotes used from it, to be made identifiable in any consultation report and any future HRA publications: All responses I am willing to be contacted by the HRA for further information in relation to this consultation or future consultations. If ‘yes’, please provide your contact details below. By providing these contact details, you are giving your consent for a member of HRA staff to contact you about your submission. The HRA takes data protection very seriously. We promise we will not pass your details on to any other organisations or use them for any other purposes. Contact Name: Enter contact name Email: Enter email address Confidentiality of Information The HRA will process your personal data in accordance with the DPA and in most circumstances this will mean that your personal data will not be disclosed to parties without your permission or unless required by law. Information we receive, including personal information, may be published or disclosed in accordance with the access to information regimes (primarily the Freedom of Information Act 2000 (FOIA), the Data Protection Act 1998 (DPA) and the Environmental Information Regulations 2004). If you want the information that you provide to be treated as confidential, please be aware that, under the FOIA, there is a statutory Code of Practice with which public authorities must comply and which deals, amongst other things, with obligations of confidence. In view of this it would be helpful if you could explain to us why you regard the information you have provided as confidential. If we receive a request for disclosure of the information we will take full account of your explanation, but we cannot give an assurance that confidentiality can be maintained in all circumstances. An automatic confidentiality disclaimer generated by your IT system will not, of itself, be regarded as binding on the HRA.