Attachment H: Record of Test Subject Participation
Record
of Test Subject Participation
Human Subject
Support for the Division of Safety Research (DSR)
Subject Name: |
|
|
|||
Date: |
|
|
|||
Protocol Number: |
|
||||
|
|
|
|||
Testing Session Experiment |
Test Completed |
Total time (hours) Note: round up to 20-minute increments |
Reimbursement ($30/hour) |
||
Experiment 1 |
|
|
|
||
Experiment 2 |
|
|
|
||
|
Total Due: |
|
|||
|
|
|
|||
___________________________________________________ |
|
|
|
||
NIOSH Staff Signature/ Date
|
|
|
|
||
Participant Signature/ Date |
|
|
|
||
|
|
|
|
||
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Haney, Justin (CDC/NIOSH/DSR/PTB) |
| File Modified | 0000-00-00 |
| File Created | 2025-05-20 |