PROTOCOL NUMBER (for office use only): ____________________

University of the Witwatersrand, Johannesburg

Ethics Application Form for Human Research Ethics Committee
(HREC Non-Medical)
(SCHOOL ETHICS COMMITTEES: Revised January 2020)

Instructions
1. This form must be completed by Honours (4th year) and Masters by Coursework
and Research Report students who require ethics clearance, or for ethics
clearance for coursework activities as part of a taught degree. Note that staff
non-degree applications, PhD and research Masters students must complete the
online form.
2. Completed applications must be submitted to the relevant School Ethics
Committee.
3. Applications may be submitted as hard or soft (electronic) copies, but the first
page of the application must contain the signatures of the student and
supervisor. Final revised versions must be in soft (electronic) copy as all
documentation will be archived.
4. Incomplete or handwritten applications will NOT be considered, including where
signatures are missing.
5. Necessary supporting documents (e.g. Participant Information Sheet, Consent
Form, copies of instruments, permission letters), must be provided.

SECTION A
Complete this checklist to show what documents you have submitted and
that you agree with the conditions of application.

Completed Ethics Application Form.

Copy of the Research proposal.
Copy of proposed Research instruments (e.g. questionnaires/interview
schedules).
Participant Information Sheets (for each different sample group and/or
instrument used).
Consent forms (for each different sample group and/or instrument used).
Relevant permission letters if required (from, e.g. company's HR
department, National authorities such as Government departments, etc.) -
consult the Guidance on the Use of Permission Letters document.

SIGNATURES (REQUIRED)
Declaration: We, the signatories, declare that all information on this form is
correct and that we will strive to maintain the highest ethical standards in
this research at all times, according to disciplinary and university
expectations, recognising that ethical practice in research is always a
continuing process.

I recognise that it is my responsibility to conduct my research in Yes No

an ethical manner according to Guidelines of the University of the
Witwatersrand, according to any laws and/or legal frameworks
that may apply, and according to the norms and expectations of
my discipline. In preparing this Application for Ethics Clearance
form, I have consulted the Guidelines for Human Research
Ethics Clearance Application/Non-Medical (available on this
website https://www.wits.ac.za/research/researcher-
 HREC (Non-Medical) Ethics Clearance Application – SCHOOL COMMITTEES

support/research-ethics/ethics-committees/). In receiving ethics

clearance, I agree to abide by the conditions of data collection as
outlined in the Guidelines document.

By signing this form, the researcher and supervisor of this project undertake
to ensure that any amendments to this project that are required by the
Human Research Ethics Committee (Non-Medical) and School Ethics
Committees are made before the project commences.

Date Name Signature*

Applica
nt
Supervi
sor
*electronic signatures are permitted but there are requirements governing this –
please see Guidelines document.

SECTION B
1. Summary of risk categories of this research project
1.1 Does this project involve human participants? Yes No

1.2 I have read and understood the risk categories table Yes No
Applicants must have read the table of risk level category
definitions on the final page of this document. This table is
also available on the University Ethics Committee
webpage.
1.3 The applicant must tick the box for the category that best applies to this project:

Risk category Tick the appropriate box

No risk
Minimal risk
Low risk
Medium risk Medium or high risk applications must be submitted by
High risk the School ethics committee to the University HREC

1.4 Are participants selected as experts? Yes No

1.5 Will human participant research involve vulnerable Yes No

categories?
If YES state which ones:

If YES, how will existing vulnerabilities among research participants be

addressed?

1.6 Does this research expose either the participant(s) or

the researcher(s) to any potential risks or harm to Yes No
which they would not otherwise be exposed?

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If YES, how will potential risks or harm be addressed?

NB: Vulnerability is context specific. The term 'vulnerable categories' includes, among others,
children under 18, orphans, prisoners, persons with cognitive or communication disorders,
people who are traumatised or currently in traumatic situations. Vulnerable categories do not
necessarily include poor or marginalised communities, older people, women, people with
disabilities (unless it results in diminished capacity to give informed consent). Not all research
involving ‘vulnerable categories’ is Medium or High Risk research: here vulnerability must be
considered in terms of the nature of the research and the context in which the research is
carried out. Where necessary, include details of steps to be taken to facilitate data collection
across language barriers (e.g. interpretation or translation).

2. Researcher's personal data

Your family name: Your first name:
Mr Ms Other :
______________
Title:
School:
Your student number:
HonourYour email:
Masters (research Other (specify) _____________________
s report)
Your tel number:
Name of supervisor(s):
Your supervisor’s Wits
email:
Your supervisor’s Wits tel
number:

3. Research project
3.1 Title of research project:

3.2 Is this research for degree purposes? Yes No

If so, for what degree?

3.3 Has it been approved by the relevant School or Faculty higher degrees
committee or other relevant unit?
Yes No Submitted and pending

3.4 Will any additional researchers be covered by this ethics protocol

(including translators/interpreters, research assistants, etc. but not including
supervisors)?
Yes No

If yes, please specify their names, affiliations and roles:

3.5 What are the aims and objectives of the research? (Please be specific)

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3.6 Summary or abstract of the research (give a brief outline of the research
plan such that reviewers can understand what will be done, 100 words maximum)

3.7 Do you have any financial or material interests or a familial

relationship associated with your research participants or with the organisations
that you will be involved with in your research?

Yes No
If yes, please explain how you will manage any existing or potential conflicts
of interest, if applicable:

4. Formal permission
4.1 Where will the research be carried out? (Please give a specific location and
/or the names of specific organisations or institutions)

4.2 Has appropriate formal permission been obtained, if required (e.g.

employer, government department, land owner, etc.)?
Yes (attached) Not Pending (must be supplied before ethics clearance can
required be given)

NB: Obtaining permission is often necessary when conducting research within the
premises of a particular site such as an ethnographic study of the functioning of a
supermarket or a school, or the way staff interact with clients in a clinic or how members
of a closed social media group interact/post on a specific topic. Permission is also required
to use data from personal communication with participants or experts. Please note that
any research done on Wits University campuses with employees or students of the
University requires formal permission from the Registrar. Please read the detailed
guidelines on Permission Letters from the Ethics website
https://www.wits.ac.za/research/researcher-support/research-ethics/ethics-committees/

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5. How will data on human research participants be collected (instruments,

methods, procedures)? (tick all applicable boxes) (NB: All applicable instruments
must be attached to the application)

Hard copy questionnaires or diagnostic tests, etc.

Online instruments (e.g. questionnaires, surveys)
Individual interviews (e.g. structured, semi-structured, etc.)
Personal communication (e.g. email or informal conversation with experts)
Group interviews (e.g. seminar/discussion groups, focus groups, etc.)
Ethnographic observation, participant observation, other informal
descriptive, and/or interactive methods (you must specify ethnographic
methods in the box below)
Autoethnography
Community-based methods or techniques such as drama workshops,
community theatre, training workshops, participant rural appraisal, rapid
rural appraisal, etc. (you must specify in the box below)
Research on/in therapeutic or counselling contexts
Putting on your own exhibition / public performance
Observation of other public performances, and/or public behaviour
observation
Photography
Video recording
Audio recording (e.g. of interviews)
Use of data from social media
Other research methods or techniques (you must specify in the box below)
Explanation of research methods specified above, and / or explanation of any other
research methods that are not listed above:

6. Who will the research participants be?

6.1 List the different participant groups (e.g. experts, community members, key
informants) that you will be working with in your project:

6.2 Description of these participant groups, including age range and sample size,
for each group:

7. How will informed consent be obtained?

7.1 How will potential participants be identified / selected / recruited?

7.2 Will any incentives be offered to participants? Yes No

(NB: it is NOT compulsory to offer any incentives.
Please note for any curricula incentives, permission is
required from the Registrar’s office and DVC. Fiscal
incentives are limited to R150 – see Guidelines
document)

If YES, please explain:

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7.3 How will informed consent be obtained?

Formal (Signed form) Informal (e.g. Other (e.g. online
If you cannot obtain formal written consent,
verbal) explain why:
survey)

NB: Attach Participant Information Sheets and Consent Forms for each sample group (please
label these carefully), and/or other related materials. It is essential that participants in
research be fully informed (irrespective of the method used) and then be able to agree on this
basis to participate in the research.

8. Protecting participant identities

8.1 Can confidentiality of participants’ responses be Yes No
guaranteed throughout the data collection process?
8.2 Can anonymity be guaranteed throughout the data Yes No
collection process?
8.3 Can anonymity be guaranteed in resulting research Yes No
reports or publications?
8.4 Explain how you will manage issues of anonymity and confidentiality in your
project (What will participants be told in this regard?):

Definitions: Confidentiality: that any information considered confidential by the participant

or researcher will not be disclosed to others. Anonymity throughout the data collection
process: that you as the researcher will not be able to identify the participant. Anonymity in
the resulting reports: that the participant’s name/identifying data will not be disclosed and
that anyone reading your results will not be able to identify the participant. NB: While
confidentiality may be desirable, it cannot be guaranteed in, for example, focus groups, or
ethnographic observations. Similarly, anonymity should be preserved in questionnaires, but
cannot be offered in workshop methodologies, focus group research, etc. Participants should
have the right to remain anonymous in the final report and this must be respected in handling
of all data relating to them. Participants need to be informed about these issues through the
Participant Information Sheet.

9. Protection of data during and after the research

9.1 How will the data be protected while the research is in progress? (This includes
how the identities of participants will be protected).

9.2 What is to be done with the research data after completion of the project?
Please note that usage of data should be consistent with what is indicated to
participants in the Participant Information Sheet and Consent Form.

Stored in archives (specify Stored in online database (specify below)

below)
Stored in password Stored in digital form with all identifying
protected computer features removed
Stored for future secondary Destroyed after … years (insert numbers
analysis of years, if applicable)

Please specify which archives or online databases will be used (if applicable):

NB: ‘Raw' or unprocessed data, especially where the identity or personal data of
research participants is included, must be safeguarded and preserved from
unauthorised access. Data may be destroyed after use, but preservation in an archive or
personal collection may also be appropriate, desirable or even essential. For instance,
datasets that contain historically important information or information that relates to
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national heritage must be preserved and should be placed in a public archive where possible
and appropriate. All data should be preserved in a way that respects the nature of the
original participants’ consent. If you are unsure about the procedure of data management
and storage, please contact the Data Services Librarian.

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10. Summary CV of applicant

ALL boxes in the following table must be completed by the applicant. Do not attach a
formal CV to your application.
10.1 List your
academic
qualifications.
Include dates or
current registration
status
10.2 Describe any
ethics content
training you have
previously received
in the previous 3
years (e.g. ethics
short courses; online
courses; ethics CPD
courses; ethical
input as part of a
research methods
course)
10.3 List of Hard copy questionnaires or diagnostic tests, etc.
instruments or Online instruments (e.g. questionnaires, surveys)
methods used in this Individual interviews (e.g. structured, semi-structured,
project, as listed in etc.)
Section 5 of the
Personal communication (e.g. email or informal
application form
conversation with experts)
(Tick the appropriate
boxes and describe Group interviews (e.g. seminar/discussion groups, focus
these specific groups, etc.)
instruments if Ethnographic observation, participant observation, other
necessary) informal descriptive, and/or interactive methods (you
must specify ethnographic methods in the box below)
Autoethnography
Community-based methods or techniques such as drama
workshops, community theatre, training workshops,
participant rural appraisal, rapid rural appraisal, etc. (you
must specify in the box below)
Research on/in therapeutic or counselling contexts
Putting on your own exhibition / public performance
Observation of other public performances, and/or public
behaviour observation
Photography
Video
Audio recording (e.g. of interviews)
Use of data from social media
Other research methods or techniques (you must specify
in the box below)
Explanation of research methods specified above, and / or
explanation of any other research methods that are not
listed above:

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10.4 Describe your

previous
experience in
deploying the
instruments or
methods of research
which you are
applying here (refer
to Section 5 and
table in Section
10.3)

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PROTOCOL NUMBER (for office use only): ____________________

HREC (Non-Medical) Risk level categories definitions (January 2020)

This table identifies broad categories of risk. Schools/Departments can provide specific examples of these categories that are specific to that particular discipline, or the types of data
collection methods or participant groups that are most common in that discipline. Please note that any study involving minors cannot be considered by Schools irrespective of the risk
level.

Risk category Definition Example Notes

No risk No contact with human participants Document analysis or literature review These studies do not require ethics
Studies based on theoretical or secondary analysis alone clearance
Use of non-human, quantitative datasets (e.g. economic data) A waiver may be given, however, if
required by a university faculty or external
body
Use of previously-collected human datasets (where permission from These studies may require ethics clearance,
previous participants have been explicitly granted) dependent on the type of study and faculty
Use of anonymized and aggregated human datasets (e.g. census data) requirements
A waiver may be given, however, if
required by a university faculty or external
body
Applications deemed No Risk can be
considered at School level
Minimal risk Where the likelihood and magnitude of Questions about people’s everyday lives, activities and opinions rather than Applications deemed Minimal Risk can be
possible harm are no greater than those detailed biographical information considered at School level
imposed by daily life in a stable society, No sensitive questions or topics
or routine educational or psychological Review of privileged information (e.g. documentation not publically
tests available)
Low risk Where the only foreseeable risks is that Questions about people’s everyday lives, activities and opinions – may Applications deemed Low Risk can be
of discomfort, or where there may be include biographical information and some potentially sensitive questions considered at School level
some sensitivity involved in terms of the and/or topics
questions asked May include some vulnerable contexts
Medium risk Where there is a likely risk of some harm Sensitive topics and/or questions that may have potential for trauma and Applications deemed Medium Risk cannot
for participants and/or the researcher, but emotional distress be considered at School level and must be
where appropriate steps can be taken to May include vulnerable categories or marginalized groups, may include referred to the main committee
mitigate or reduce risk some types of low-level illegal activities, such as artisanal mining Support/counselling services must be
Research locality itself may contain potential risks to the participants and/or provided for participants, if appropriate
researcher A distress protocol should be given, if
There is a clear justification to undertake the research using this participant appropriate
group and/or using the proposed instruments, despite the potential risks
High risk Where there is a real and foreseeable risk Highly sensitive topics, e.g. experiences of violence, rape, illegal activities Applications deemed High Risk cannot be
of harm which may lead to serious Vulnerable or marginalized groups, or where multiple vulnerabilities exist considered at School level and must be
 HREC (Non-Medical) Ethics Clearance Application – SCHOOL COMMITTEES

adverse consequences if not managed in Research involving deception of the participants referred to the main committee
a responsible manner Research involving serious illegal and criminalized activities, such as Remedial interventions by external
violence, fraud professionals can be taken should harm
Where the participants place themselves at risk of harm if they participate occur
Where the researcher may place themselves at risk of harm Support/counselling services must be
Where the researcher may place themselves at risk of breaking the law provided for participants and/or for the
Where the research may reveal information that may place the participant or researcher
others at risk (e.g. victims of abuse, violence), requiring intervention from A distress protocol and debriefing strategy
government, university or other institutions should be given, if appropriate
There is a clear justification to undertake the research using this participant
group and/or using the proposed instruments, despite the potential risks

NOTES:

(1) Definitions of terms

Discomfort refers to a sensation of uneasiness, disturbance or mild pain.

Harm refers to damage incurred (which may include physical, psychological/emotional, social, economic or legal harm) as an
outcome of an action, or through emotional distress.

Risk refers to (i) the likelihood of exposure to a particular negative consequence, and/or (ii) the magnitude of the possible
consequences of exposure, and/or (iii) the possibility that research could result in harm.

(2) Discussion of risk

Individuals that may be at increased risk include:

• Those who are dependent/reliant on the institution/person who provides/mediates access to researchers;

• Those who are involved in illegal activities or who are criminalized by the state, e.g. drug dealers, sex workers, undocumented
migrants.

NB: it is essential to consider the individual – not an aggregated group – when assessing risk.

(3) Discussion of vulnerability

Vulnerability can stem from: a lack of capacity or impaired ability to provide voluntary informed consent; health status; social
pressures that may impact on the ability to make a free and informed decision; an inability to protect one’s interests in research.

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Vulnerability may be considered as dynamic and specific to a particular context, and may arise as a result of power asymmetries
between participants and researchers/institutions. There may be layers of vulnerability that function and interact within a
participant’s circumstances. Being vulnerable does not necessarily imply that harm or exploitation will occur, but it does increase
the risk of harm or exploitation through research.

In addition to those in vulnerable categories, vulnerability may also include individuals whose ability to provide informed consent
may be reduced where:

• Their decision-making capacity is limited due to individual mental health status;

• Their decision-making capacity is limited due to the environment in which they live/work, e.g. prisoners/detainees, residents of
drug rehabilitation centres;

• They are under 18 years of age;

• They are dependent on the state to maintain a legal status, e.g. documented asylum seekers, documented refugees.

NB: it is essential to consider the individual – not an aggregated group – when assessing vulnerability.

The researcher needs to minimise the risk of harm, ensure that the consent process supports a truly informed decision, and put in
place additional measures to ensure ethical involvement of vulnerable groups. Where necessary, include details of steps to be
taken to facilitate data collection across language barriers (e.g. interpretation or translation) and/or in cases of illiteracy.

Useful references:

Bracken-Roche, D., Bell, E., Macdonald, M.E. and Racine, E. (2017). The concept of ‘vulnerability’ in research ethics: an in-depth
analysis of policies and guidelines. Health Research Policy and Systems, 15 (1), 8, doi:10.1186/s12961-016-0164-6.

Horn, L., Sleem, H. and Ndebele, P. (2014). Research vulnerability. In: M. Kruger, P. Ndebele and L. Horn (Eds.), Research ethics in
Africa: A resource for research ethics committees. Stellenbosch: SUN Press, pp. 81-90.

(4) Distress protocol

A ‘distress protocol’ is a procedure to follow in emergency situations where, for example, a participant becomes clearly distressed
during an interview. Under such situations, the interview is terminated and the distress protocol is enacted. Researchers may need
to consider:

1. The possible distress experienced by the participant: e.g. questions that address issues of abuse, abandonment, previous
negative sexual experiences, or traumatic memories that may induce distress. A distress protocol must include the name and

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contact details of an appropriate provider who can provide support, at no cost to the participant. This may include counselling
services or access to NGOs/law clinics;

2. The possible distress experienced by the researcher: this may include provisions for how the safety of the researcher will be
supported, and should be discussed with supervisor and the name and contact details for counselling services provided if needed.

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