Republic of the Philippines

Department of Health
SINGLE JOINT RESEARCH ETHICS BOARD

SJREB FORM 6
CHECKLIST FOR EXEMPTION FROM FULL ETHICAL REVIEW
FORM
To be filled up by primary reviewer

SJREB Protocol No. Date (D/M/Y):

Protocol Title:

Coordinating
Investigator:

A. Protocol Assessment
Questions Comment/s:
1. Does this research involve human
participants?
Yes No
2. Does this research involve use of non-
identifiable human tissue/ biological
samples?
Yes No
3. Does this research involve use of non-
identifiable publicly available data?
Yes No
*Protocols that neither involve human participants, nor identifiable human tissue, biological samples
and data shall be exempted from review (NEGHHR 2017)
4. Does this research involve interaction
with human participants
Yes No
5. Type of research (please tick appropriate box)

a. Institutional quality assurance

Yes No
b. Evaluation of public service program
Yes No
c. Public health surveillance
Yes No
d. Educational evaluation activities
Yes No
 e. Consumer acceptability test
Yes No
*These 5 have been identified in the NEGHHR as exemptible, as long as it does not involve more than
minimal risk.
6. What is/are the method/s of data collection (please tick appropriate box)

a. Surveys and/or questionnaire

Yes No
b. Interviews or focus group discussion
Yes No
c. Public observations
Yes No
d. Research which only uses existing
data
Yes No
e. Audio/video recordings
Yes No
*These 5 have been identified in the NEGHHR as exemptible, as long as anonymity and/or
confidentiality is maintained.
7. Will the collected data be anonymized or
identifiable?
Anonymized Identifiable
De-identified
8. Is this research likely to involve any
foreseeable risk of harm or discomfort to
participants; above the level experienced
in everyday life? (NEGHRR 2017)
*Please refer to section B. Risk
Assessment, prior to answering this item
Yes No
*If YES, then this protocol does not qualify for exemption

B. Risk Assessment
Questions Comment/s
1. Does this research involve the following: (please check all that applies)

a. Any vulnerable groups?

Yes No
b. Sensitive topics that may make
participants feel uncomfortable (i.e.
sexual behaviour, illegal activities,
racial biases, etc.
 Yes No
c. Use of drugs
Yes No
d. Invasive procedure (e.g. blood
sampling)
Yes No
e. Physical stress/distress, discomfort
Yes No
f. Psychological/mental stress/distress
Yes No
g. Deception of/or withholding
information from subjects
Yes No
h. Access to data by individuals or
organizations other than the
investigators
Yes No
i. Conflict of interest issues
Yes No
j. Or any other ethical dilemmas
Yes No
k. Is there any blood sampling involved
in the study
Yes No

C. RECOMMENDATION

Qualified for Exemption

Decision:
Unqualified for Exemption

Summary of
comments:

Reviewer’s Name: Date:

Signature: