COVID-19 PsyImpact & PsySafe Program
INFORMED CONSENT FORM
The study is intended exclusively for adult participants.
You are invited to participate in an international study which aims to find out the impact of the COVID-19 pandemic on the mental health of staff at high risk of contamination (health, emergencies, public order, defense and national security) and the general population, to identify factors that may reduce the risk of anxiety disorders and to test the effectiveness of a pilot program that increases stress resilience, maintains mental health and prevents burnout.
Sebastian-Mihai ARMEAN -
VOLUNTARY PARTICIPATION, WITHDRAWAL FROM THE STUDY AND CONFIDENTIALITY
Your participation is entirely voluntary and you can withdraw at any time. The results can be presented at scientific events or published in scientific journals. Your personal information will not be disclosed. Data storage will be done according to the European Regulation on Personal Data Protection no. 679/2016 (GDPR).
This research received the approval of the Ethics Committee of the "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca (Romania). Upon request, the extended form and the research protocol can be made available to you.
Estimated TIME of completion: 8 minutes
By continuing to the survey, I EXPRESS MY CONSENT to take part in the study.
NOTE: To simplify the questionnaire, the term COVID-19 refers to both the disease caused by the virus and the name of the virus (SARS-CoV-2).
As the study is conducted in 3 (three) stages, we collect your email address so that we can send you the other questionnaires and select you in the pilot program, if applicable.
I am an adult participant
Prefer not to say
Profession (if not in the list, please add)
Clergy (Priest, Pastor, Imam, Rabbi, etc)
Medical Trainee (Dental Medicine included)
Medical Specialist (Dental Medicine included)
Pharmacist (Specialist and/or Trainee included)
Liberal professions, Administrative or Executive personnel (please indicate job position below)
If healthcare professional, please specify specialty/department
Your partner works as (if applicable)
Are you or have you been infected with COVID-19?
I do not know
Have you been placed in self-isolation or quarantine?
Do you know someone (family member, relative, friend, neighbor) who suffers/suffered from COVID-19? What is his/her current status?
I do not know such person
The person is healthy
The person is still ill
The person has deceased
Page 1 of 5
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service