Data Privacy & Confidentiality Ethics Form
Full Name
Position / Role
Department / Organization
Project / Study Title
Type of Data Involved
Who will have access to the data?
How will the data be stored and secured?
Will data be shared with third parties? If yes, describe how safeguards will be ensured.
How long will the data be retained?
Consent Obtained?
Yes
No
Describe methods to ensure confidentiality and privacy.
Potential risks to data privacy and how they will be mitigated.
By signing below, I confirm that I understand and will comply with data privacy and confidentiality requirements.