Consent 1

INFORMED CONSENT FORM
This informed consent is for participants who are willing and understand the information
explaining the above research and have the opportunity to ask a question and, who the
researchers are inviting to participate in our study entitled:
“BODY MASS INDEX AND CORRELATION TO SOCIO-DEMOGRAPHIC STATUS
OF BAGUIO CITY POLICE OFFICERS”
Names of the researchers

1. Basi, Pauline
2. Novencido, Mary Grace
3. Pregillana, Mariel
4. Yeboah-Djan, Angelina
Name of Research adviser
1. Angela Bethsaida Laguipo
This Informed Consent Form has two parts:

 Part I. Information Sheet
 Part II. Certificate of Consent
You will be given a copy of the full Informed Consent Form
PART I: INFORMATION SHEET
Introduction
We, the students of the University of Baguio -School of Nursing, are doing research on the
BMI and Correlation to socio-demographic status of Baguio City police officers. The researchers
are here to invite you to be a part of the survey. Please take time to decide whether you will or
will not participate in the research, and please read the information given. If you need
clarification please approach us.
Purpose of the research

Police officers experienced obesity and other diseases that contribute to their physical
activities but also for them to be aware of how to be healthy and have a proper diet. The main
focus of the study is to control obesity, prevent the associated diseases and maintain physical
wellness among the police officers of Baguio City.
Type of Research Questionnaire

This research will involve your participation in answering a questionnaire that takes about
20 minutes. The questionnaire will consist of socio-demogrphic questions and can be answered
by ticking on the blanks provided.
Participant Selection
The participants of the study will be the Police officers who are employed more than two
months in the service as a police officer in Baguio City.
Voluntary Participation
Your participation in this research is entirely voluntary. It is your choice whether to
participate or not. You may change your mind later and stop participating even if you signed
earlier.
Procedures
The researchers are inviting you to take part in this research project. If you accept, you
will be asked to answer a survey provided and collected by 2 of the researchers whose names
appeared above.
The survey has 3 parts that contain questions about diet, sleeping habits, and exercise.
The research is asking you to answer all question not leaving any blank. Your identity and
answers will be kept confidential that only members of the research team will gain access for the
research purposes only.
Duration
The research will take place in about 2-3 months. During that time, the researchers will
only visit you once to answer the survey. The survey questions will only take you 15 minutes to
answer.
Risks
The study participation is not expected to convey any risks to you as there will be no
intervention to be introduced. However, if you feel uncomfortable with the questions, you may
not proceed from answering the survey.
Benefits
This study will allow you to gain insight on how you can do health self-assessment which
will be discussed to you by the researchers.
Reimbursements
No incentives will be provided for you to take part in our research. The researchers would
be the one to approach you in your place and we will let you answer only at your convenient
time. We will make sure that we will not interfere with your plans and activities.
Confidentiality
Your privacy and anonymity, as well as your confidentiality, will be ensured. The
questionnaire that you answered will only be handled by the researchers and it will be kept in a
sealed envelope. Your shared data will only be discussed among the researchers.
Sharing the Results

Nothing that you answered today will be shared with anybody outside the research and
nothing will be attributed to you by name. The knowledge that we got from doing this research
will be shared if you are interested before it is made widely available to the public through the
manuscript, publications in health or nursing journals and even through oral or poster
presentation in professional conferences.
Right to Refuse or Withdraw

You will be informed that you do not have to take part in this research if you do not wish to
do so; you have the right to withdraw for any reason from the study at any time during the
research process.
Who to contact
You can call or ask questions anytime regarding this study. If you wish to ask questions
later; you may contact Ms. Angela Bethsaida Laguipo at +63 998 8544 974.
PART II: CERTIFICATE OF CONSENT

I have read the foregoing information, or it has been read to me. I have had the
opportunity to ask questions about it and any questions I have been asked have been
answered to my satisfaction. I consent voluntarily to be a participant in this study.
Print Name of Participant: _________________
Signature of Participant: ___________________
Date: [MM/DD/YYYY] _____________________
If Illiterate
A literate witness must sign (if possible, this person should be selected by the participant and
should have no connection to the research team). Participants who are illiterate should include
their thumbprint as well.
I have witnessed the accurate reading of the consent form to the potential participant, and
the individual has had the opportunity to ask questions. I confirm that the individual has
given consent freely.
Print name of witness____________ Thumb print of participant:
Signature of witness _____________
Date: [MM/DD/YYYY] __________
STATEMENT BY THE RESEARCHER OR PERSON TAKING CONSENT

I have accurately read out the information sheet to the potential participant, and to the best
of my ability made sure that the participant understands that the following will be done:
1.
2.
3.
I confirm that the participant was given an opportunity to ask questions about the study,
and all the questions asked by the participant have been answered correctly and to the best
of my ability. I confirm that the individual has not been coerced into giving consent, and
the consent has been given freely and voluntarily.
A copy of this Informed Consent Form has been provided to the participant.
Print Name of Researcher or person taking the consent

________________________
Signature of Researcher or person taking the consent

_________________________
Date: <MM/DD/YYYY>______________

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INFORMED CONSENT FORM

Names of the researchers

This Informed Consent Form has two parts:

You will be given a copy of the full Informed Consent Form

PART I: INFORMATION SHEET

Purpose of the research

Type of Research Questionnaire

Sharing the Results

Right to Refuse or Withdraw

PART II: CERTIFICATE OF CONSENT

STATEMENT BY THE RESEARCHER OR PERSON TAKING CONSENT

Print Name of Researcher or person taking the consent

Signature of Researcher or person taking the consent

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