Auxiliary Survey Informed Consent Page - CGIRB Approval

Participant Informed Consent Form
Privacy and Informed Consent: In accordance with Public Law 93-579, the Privacy
Act of 1974 and 45 CFR Part 46, providing the information requested in the survey is
voluntary. Your informed consent is required for participation.
______________________________________________________________________________________

I understand that the purpose of this survey is to enhance the safety of USCG Auxiliarists
operations. This safety survey will be limited to data collection that solicits strictly
voluntary opinions and will not collect information which is required or regulated.
I understand that, as a recipient of this e-mail, I am being asked to participate in an online
survey.
Benefits: The benefit of my participation will be feedback to my leadership team to
facilitate communications between members of the command, focus management
attention to employee issues, and highlight areas to improve the overall work
environment. There will be no direct benefit to me for my participation.
Risks: There are minimal to no risks anticipated with my contribution to this survey. I
acknowledge that my basic demographics (what AUX region, aircrew qualification, etc.)
will be collected in this survey and that my responses will be used by and disclosed to
Coast Guard personnel and Auxiliarists who need the information to assist in activities
related to Coast Guard operations. In this respect, the confidentiality of my responses
cannot be assured, however, there will be no attempts to link me to my responses and I
will remain anonymous. Data reported from this survey will be summarized and will not
single out any individual participant’s responses.
Subject Assurances: My participation is voluntary. I will be asked to answer every
question, even if my answer is "N/A," to help ensure statistical validity. I understand that
I have the right to withdraw my participation at any time, prior to submission of the
completed survey, without penalty.
Point-of-Contact about the Study: If I have any concerns, questions or want further
information about this survey, I will contact D5 AUXSAT Brian Lynch at
[email protected].
For further questions regarding research subjects’ protection, I can contact the CG
Human Research Protection Office at [email protected] or at (202) 4755182.
Consent: I have read this consent form and understand its contents. By participating in
this survey, I am implying consent and no signed documentation will be required. By
clicking the link below, I acknowledge that I freely consent to participate in this survey
under the conditions described.

CGIRB APPROVED
08 OCT 2014