Explanatory Note

This model is intended for VUB research. 

For clinical studies, see the UZ Brussel website.  

For bachelor and master projects, see a specific model on the SharePoint DPO. 

Dear researcher,

You are about to process personal data for your research. Your research is thus subject to privacy legislation, including the General Data Protection Regulation 2016/679 (GDPR) and the Privacy Act of 30 July 2018.

The rights of data subjects are best served when asking for an explicit consent for the processing of their personal data. If that is practically unfeasible (too many people involved, difficult to contact them, …) or undesirable (the possibility to withdraw the consent would be problematic, informing the participants might distort the research results, …), you may opt for the “public interest” as a legal ground, if your research is in the public interest. As a rule, this is the case for fundamental academic research. Research serving only private, industrial or commercial purposes, will usually not be considered to be in the public interest.

If you wish to opt for “public interest” as a legal ground, please discuss this with the DPO ([email protected]). In this case, you should still provide transparency towards the data subjects by publishing a privacy policy (on your website).

The informed consent form must be written in a language that is clear and understandable:

• short sentences
• text tailored to the participants (anguage, age, level of education, …)
• avoid professional jargon as much as possible;
• limit the use of abbreviations.

If possible, please read this document with the participants and give them all necessary explanations.

When dealing with minors, consent should be given by the parent(s) or legal guardians. Minors of 13 years or older should also consent themselves.

Limit the processing of personal data as much as possible: do not collect data you don’t need, transcribe interviews as soon as possible (if you do not need the image, sound, body language, reactions), etc.

Please fill in the form, delete where not applicable and delete the comments in italic and red before you submit the form to the participants.

Please observe our burden of proof of all consents given: these should be securely stored and easily presented when asked for.

Do not forget:

-       to apply for ethical advice when needed (cf. the Guide for the researcher)

-       to ensure safe data storage

-       to contact our data stewards ([email protected]) for guidance on data management and storage and drafting data management plans

-       to declare your processing of personal data into the register of processing activities.

In case of clinical study, you will find specific informed consent forms on the UZ Brussel website. 

You can find more information regarding personal data and scientific research on the DPO SharePoint.

Good luck with your research!

We propose you to participate in scientific research.

You can stop your participation at any time (in writing or verbally), without giving a reason.

You will find more information about the research below. Do not hesitate to ask questions to the researcher if something is not clear.

1.    Description of the research

·      Title: …

·      Researchers: … name, contact details

·      Supervisor: … name, contact details

·      Research group or department: …

·      Purpose of the research: …

·      Practical conduct: interviews/questionnaires/focus groups/experiments. + additional information: number and duration of the interviews, recordings, time required to fill in the questionnaire, number and duration of focus groups, research period, …

2.    Responsible data controller

VUB (Vrije Universiteit Brussel), Pleinlaan 2, 1050 Brussels, company number 449.012.406.

3.    Conditions to participate

Describe the inclusion-/exclusion criteria

4.    If applicable: Description of risks and benefits

Your participation will not involve any risks.

[or] Your participation will involve the following risks: … .

Your participation will not involve any benefits.

[or] Your participation will involve the following benefits: … .

5.    Confidentiality

We will keep the collected data confidential and respect the privacy legislation, including the European General Data Protection Regulation (GDPR).

6.    Data – Purpose – Retention Time – Transfer

For this research, we will collect the following personal data:

[name, age, gender, email address, IP address, information observed or requested, such as “your opinion on...”, “your experiences with...”,...]

If applicable: and the following sensitive personal data:

[data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, genetic data, biometric data, data concerning health or data concerning a person's sex life or sexual orientation]

We will only process your data for the purpose of scientific research.

We will store your data for x years (as a rule ten years - cf. https://vub.sharepoint.com/sites/PUB_RD_DM/SitePages/New-RDM-policy.aspx, art. 8.3) after the end of the research.

Your data may be re-used for the purposes of scientific research in the general interest, in the EU and in countries recognized by the European Commission as providing adequate protection, under the condition that protection measures are taken.

If applicable: If you mark your specific consent for that purpose, we may share your data with …………….., for the following purpose: …………….. .Otherwise, your data will not be transferred to any third parties, unless with your explicit consent or due to a legal obligation.

7.    Citations

Without your express consent, you will not be cited in any publications .

8.    Security

The storage of your data will offer a high degree of protection, in accordance with the guidelines of VUB (VUB Charter of the Researcher, ICT Security policy).

We will pseudonymize your data as soon as possible. This means that we will replace data that can directly identify you, such as your name and e-mail address, by codes. A "translation key" will be necessary to convert the codes back to the original data. Only the researchers and the supervisor have access to this key. 

If applicable: We will anonymize your data as soon as possible. This means that it will no longer be possible to identify you by means of the data. (be aware that anonymity is difficult to achieve and often comes at the cost of reduced data utility)

Exceptionnally, e.g. when interviewing experts and it is important to mention their name, you might not pseudonymize or anonymize the data. In that case, the two paragragraphs above should be deleted.

9.    Your rights

You have the right to access, correct and erase your data, request information on the way we handle your data, request a copy of your data, limit the way we handle your data and ask us to transfer your data to third parties.

You are entitled to withdraw the consent to process your data at any time, without having to justify your request.

The exercise of your rights may be limited if this would seriously complicate our research. For example, if you withdraw your consent, we might continue to use the data we had collected before the withdrawal of your consent.

10. Contact

If you have questions or if you wish to exercise your rights, you can contact (name and contact details of the researchers or the supervisor) or the data protection officer of VUB ([email protected]).

11. Complaints

If you wish to complain about the way we handle your data, you can contact the researchers, the supervisor or the DPO (cf. above).

Or you can file a complaint with the data protection authority:

Drukpersstraat 35, 1000 Brussel 

Tel. +32 2 274 48 00 

email: [email protected] 

website: www.dataprotectionauthority.be 

12. Declaration of the researchers

The undersigned researchers confirm that the participant has received a copy of the present document and that they have answered all its possible questions.

name: …                                                               name: …

date: …                                                                 date: …

signature: …                                                          signature: …

13. Consent of the participant

if applicable: If one of the options listed below is essential to participate and if you do not agree, please do not return this form to the researchers.

O  I have had the opportunity to ask questions and agree to participate in the research.

O  If applicable: I confirm that I fulfil the conditions to participate

O  I understand that my participation in this research is voluntary and that I can stop my participation at any time, without having to give a reason. 

O  I agree with the collection of the following data for the research: … name, age, gender, email address, IP address, observation notes (specify), …

O  If applicable: I agree with the collection of the following sensitive data for the research: ... data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, genetic data, biometric data, data concerning health, data concerning sex life or sexual orientation

Recordings (if applicable)

O  I do not agree that audio or video recordings will be made. Notes will be taken instead.

or 

O  I agree that audio or video recordings will be made. The recordings will be converted to transcriptions and deleted as soon as possible.  

If applicable: Please note that your consent that audio or video recordings will be made is essential. If you do not agree, you will not be able to participate in the research.        

Publications, conferences, etc.

O  I consent to the disclosure of the research results in a publication, conference or otherwise, without revealing my name or any other data that could identify me.

O  exceptionnally, e.g. when interviewing experts and it is important to mention their name: I consent to the disclosure of the research results in a publication, conference or otherwise, and to mention my name.

If applicable: Please note that your consent to disclosing research results in a publication, conference or otherwise and to mention your name is essential. If you do not agree, you will not be able to participate in the research.  

Citations (if applicable)

O  I agree to be cited in publications concerning the research, without revealing my name or any other data that could identify me.

or

O  I do not agree to be cited in publications concerning the research.

If applicable: Please note that your acceptance to be cited is essential. If you do not agree, you will not be able to participate in the research.

     or

O  exceptionnally, e.g. when interviewing experts and it is important to mention their name: I agree that my name will be mentioned when I am cited in publications concerning the research.

or

O  I do not agree that my name will be mentioned when I am cited in publications concerning the research.

If applicable: Please note that your acceptance to the mentioning of your name when you are cited in publications is essential. If you do not agree, you will not be able to participate in the research.

Transfer of data to third parties for commercial or other non-scientific use (if applicable)

O  II agree to the pseudonymised research data (without my name or other data that might identify me directly) being shared with the following third parties for commercial or other non-scientific use: …........

VUB will conclude contracts with these parties, imposing sufficient guarantees for the protection of your data.

If applicable: Please note that your consent to the research data being shared as described above is essential. If you do not agree, you will not be able to participate in the research.    

name: …

date: …

signature: …