To take the survey, please review the information below and then click “I Agree” at the bottom of this page.
Greetings! The enclosed information is part of a request to complete a survey that will support research on home sewage treatment systems. We appreciate you taking the time to read this and respond to the survey.
Your neighbors at Rural Action and Ohio University
Information about consent to participate in the survey:
You are being asked by an Ohio University researcher to participate in research. For you to be able to decide whether you want to participate in this project, you should understand what the project is about, as well as the possible risks and benefits in order to make an informed decision. This process is known as informed consent. This form describes the purpose, procedures, possible benefits, and risks of the research project. It also explains how your personal information will be used and protected. Once you have read this form and your questions about the study are answered, you are asked to complete the enclosed survey or use the link provided on the enclosed information sheet to complete the survey online.
Title of Research: Survey about home sewage treatment systems
Contact information for researchers:
Ohio University- Sarah Davis, firstname.lastname@example.org
IRB number: 19-E-373
Summary of Study
This research is being conducted to determine if it is possible to reduce the cost of home sewage treatment system (HSTS) maintenance by creating a valuable fertilizer from HSTS waste (septage – solids in a septic tank). An information sheet about HSTS is enclosed.
Explanation of Study
This study is being done because 25% of HSTSs in Ohio are failing. 120 million gallons of improperly treated wastewater from these failing systems is polluting Ohio’s water resources each day. Currently, community conversations are not happening around this topic. Septage contains valuable nutrients that are currently being thrown away in landfills, wastewater treatment plants, or through land application.
If you agree to participate, you will answer the enclosed series of questions and return them via mail in the enclosed return envelope.
You should not participate in this study if you are under 18 years of age.
Benefits and Risks:
This study is important because it seeks to identify feasible solutions for reducing soil and water pollution.
Individually, you may benefit from the study if a technology is identified that can add value to septage wastes and reduce the cost of HSTS maintenance. Depending on the outcomes of the study, there may be no benefits but there are also no harms.
No personally identified information will be recorded with your survey responses.
Confidentiality and Records
Your survey responses will be kept confidential by immediately separating any personally identifiable information from the survey answers. No personal information is required to complete the survey.
Additionally, while every effort will be made to keep your survey related information confidential, there may be circumstances where this information must be shared with:
* Federal agencies, for example the Office of Human Research Protections, whose responsibility is to protect human subjects in research;
* Representatives of Ohio University (OU), including the Institutional Review Board, a committee that oversees the research at OU;
* Rural Action personnel that are collating survey results.
You may enter a drawing for $50 gift card, with chances of winning estimated to be approximately 1 out 125. To enter the drawing, contact information can be provide on a separate sheet of paper that will be kept in a secure location separate from survey responses. If you complete the online survey, contact information will be entered into a database that is separate from the survey responses.
If you have any questions regarding this study, please contact the investigator
Sarah Davis, email@example.com, 740-597-1459
If you have any questions regarding your rights as a research participant, please contact Dr. Chris Hayhow, Director of Research Compliance, Ohio University, (740)593-0664 or firstname.lastname@example.org.
By completing the survey and agreeing to participate in this study, you are agreeing that:
- you have read this consent form (or it has been read to you) and have been given the opportunity to ask questions and have them answered;
- you have been informed of potential risks and they have been explained to your satisfaction;
- you understand Ohio University has no funds set aside for any injuries you might receive as a result of participating in this study;
- you are 18 years of age or older;
- your participation in this research is completely voluntary;
- you may leave the study at any time; if you decide to stop participating in the study, there will be no penalty to you and you will not lose any benefits to which you are otherwise entitled.
Version Date: [11/20/2019]