Study title:
Funding organization:
Principal investigator:
Survey administrator: [Name, organization and email address]
1. Purpose of the study
2. Who takes part in the study
3. Procedure
The survey consists of several parts related to a different topic each. You are kindly asked to answer as many questions as you can. Answers are saved automatically each time you click on “Next” in the online-survey interface. You can interrupt the survey any moment by clicking “Resume later” at the top of each survey page and come back at a later point in time for final submission. Should you change your mind about answering the survey and want your data deleted you can click on “Exit and clear survey” (also at the top of each page) any time before pressing the "Submit" button located at the last page of the survey.
4. Confidentiality
This questionnaire will be filled out by individuals who belong to the [your institution], anonymously. Your confidentiality will be protected at all times. The online-survey is hosted by on a private virtual server managed by CDmon in a Spanish Data Center, contracted by Fundació per a la Universitat Oberta de Catalunya (FUOC).
All data that could potentially be used to identify you indirectly (such as professional position, the name of your organisation) will be pseudoanomised after the completion of the survey; the analysis of the data will operate with the pseudo-anonymised dataset.
The current survey uses a [anonymised response | anonymised response with tracking | anonymized response with participant database] mode.
[“Anonymised response” mode means that for this particular survey instance, the Limesurvey platform is configured in such a manner as to not store any meta-information that could be potentially used to link your submission to your person, including the IP address of the computer used, the date and time of your submission or the URL referrer. Nevertheless, you can interrupt the survey any moment by clicking “Resume later” at the top of each survey page and come back at a later point in time for final submission. You can "Exit and clear" your submission any time before the final submission by clicking on the corresponding button at the top of any page. Once you have finalized the submission by pressing the "Submit" button at the end of the survey, you cannot delete your data anymore nor can you request its deletion from the survey administrator. We cannot identify your entry in the overall dataset containing all responses. Your submission is anonymous since no personal identifier is stored with your entry in the results table.]
“Anonymised response with tracking” mode means that for this particular survey instance, the Limesurvey platform is configured in such a manner that it uses a random identifier (also called “token”) to keep track of your submission. We also store with each submission the following meta-information: IP address of computer used, date and time of submission and URL referrer. You can interrupt and resume your submission at any time - without manually clicking the "Resume later” button at the top of any page. You can also "Exit and clear" your submission any time before the final submission by clicking on the corresponding button at the top of any page. Once you finalize your submission by clicking the "Submit" button on the last page of the survey, you cannot delete your submission anymore. You can request the deletion of your submission by writing an email to the survey administrator providing the IP address, date and time of your submission. If your entry can be identified unambiguously based upon this information, it can be deleted. Your submission is anonymous since no personal identifier is stored with your entry in the results table.]
[“Anonymised response with participant table” mode means that for this particular survey instance we use a LimeSurvey internal database containing participants names and emails to personalize invitations and reminders as well as keeping track of response rates. We also store with each submission the following meta-information: IP address of computer used, date and time of submission and URL referrer. You can interrupt and resume your submission at any time - without manually clicking the "Resume later” button at the top of any page. You can also "Exit and clear" your submission any time including after the final submission by using the personalized survey link send to you and clicking on "Exit and clear" button on the top of any page. Once the survey has been finalized, you can request a deletion of your submission from the result dataset by writing an email to the survey administrator; the email address from which the request is send needs to match the entry in our participant database. Under no circumstances will your personal information (email and name) stored in the participant database be linked to the final result dataset containing survey submissions. Your submission is anonymous since no personal identifier is stored with your entry in the results table.]
Administrative access to the current survey instance and hence data in non-aggregated form is granted to the following persons:
• The survey administrator: [Fill in name, organization and email]
• The Limesurvey administrator: Jörg Müller, Universitat Oberta de Catalunya, jmuller@uoc.edu
The website platform is also certified with secure protocols (SSL) that ensure encryption mechanisms to allow the secure transmission of data over the network.
Your personal data will be treated in accordance with the privacy policy of [specify data protection policy of your organisation, including link for consultation]. You can exercise your rights of accessing, modifying, opposing, and cancelling your data by contacting us via email at [email and name of survey admin], in case the present survey was carried out in mode "Anonymised response with participant table". These rights are protected by the European General Data Protection Regulation (GDPR 2016/679) and by the Spanish Organic Law 3/2018 of 5 December 2018, on the Protection of Personal Data and the Warranty of Digital Rights.
5. Dissemination of findings
[DESCRIBE HOW RESULTS WILL BE USED]
6. Complaints
Any complaints regarding the ethical aspects of this study should be directed to the email of the Ethics Committee of [REPLACE WITH NAME OF ETHICS COMMITTEE OF YOUR ORGANISATION]
8. Who to contact if you have any questions
If you have any questions about this survey, please contact [email and name of survey admin].