Hazardous Waste Manifest Research Participant Consent Form

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Research consent form

We are working to improve the hazardous waste manifest service. To do this, we are asking people who use the service to participate in an online video conferencing session to speak about their experience with the process, and test new design approaches.
 
Audio Recording and Transcripts
During the study, the interviewers may take notes, make audio or video recordings or photographs to assist in the analysis. Your name and other identifiers will not be associated with the recordings, nor will the recordings be used for any purpose other than those described in this form or otherwise permitted by law. The recordings may be used for training or evaluation purposes.
 
All recordings, transcripts and notes will be stored for the duration of the project and then securely disposed of as transitory records in accordance with the Information Management Act and related policies.
 
Confidentiality
Your confidentiality will be respected.  We will de-identify all notes and ask that you not name yourself or others in audio or video recordings.  You can choose to not be included in those recordings.
 
In capturing individuals’ stories and experiences, personal information of a confidential nature may be shared during the interview. In compliance with the Freedom of Information and Protection of Privacy Act, all personal information will be protected using appropriate security controls.
 
Collection Notification
This information is collected by the Ministry of Citizens’ Services – GDX under section 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act, and will be used for the purpose of assisting analysis in the project described above. It may be used for training or evaluation purposes. If you have question about how your information is used, please contact:
 
Meg Stiven
Manger, Service Design
meg.stiven@gov.bc.ca
617 Government St.
Victoria, BC V8V 1X6
250-893-1170

I agree to being video recorded for the purposes described above.
I agree to being audio taped for the purposes described above.
Missing or incorrect value
I agree to screen capture recording for the purposes described above.
Please select an option

I understand the following:
  • I have read and understood the Participant Consent form
  • I have had the opportunity to ask question and have had satisfactory responses to my questions
  • I will receive a dated and signed copy of this form
Missing or incorrect value
Please provide a valid email address
Missing or incorrect valueMM/DD/YYYY

We'd like to provide you a gift card to thank you for taking the time to participate in this research.
 
You will receive a $25 electronic gift card by email from Virtual Incentives after the session. You will have the option to choose the type of gift card you want.
 
You are entitled to the gift card regardless of you completing the session.
Collection Notification
Your personal information is collected through Virtual Incentives under section 26(c) and section 26 (e) of the Freedom of Information and Protection of Privacy Act, for the purpose of delivering and confirming that you have received your e-Gift card.
 
Registration of your e-Gift card through Virtual Incentives is voluntary. Please be aware that your IP address, email address and e-Gift details will be collected by Virtual Incentives, and this information will be stored and may be accessed outside of Canada. By selecting "yes" you are consenting to your personal information (IP address, email address and e-Gift details) being stored and/or potentially accessed outside Canada. Your consent is effective as soon as you submit.
 
If you have any questions about the collection, use or disclosure of your personal information, please contact:
 
Meg Stiven
Manger, Service Design
meg.stiven@gov.bc.ca
617 Government St.
Victoria, BC V8V 1X6
250-893-1170
aeabc6994ffe44fa2658af491b11890f5b5a337c
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