ࡱ> gf ibjbj// :jEgEgn n 8L4H)&sss((((((($n+$.L(sssss()s(s(rK&TK'qa&()0H)&p.p.K'p.K'hsssssss((sssH)ssssp.sssssssssn X : Post: Line Manager/Supervisor: Department: Post Holder (where known): Trust/s working with: Period of appointment/contract request: Project Title (if known): Type of research activity researcher will be conducting (*Delete as appropriate)Criminal record check necessary3? Is this Regulated activity Occupational Health Check Necessary? (*Delete/address question as appropriate)Research activities being undertaken (mark with x) *Address questions marked with * LoA or HRCResearcher is a health care professional4 providing healthcare5 to: *Adults/ChildrenYes enhancedYes, if done once this is Regulated Activity (new definition). Requires enhanced CRB + appropriate barred list checkYes, if there is direct contact *YES/NOHRCResearcher provides health care to *Adults/Children under the direct supervision of a healthcare professionalYes, enhancedYes, if done once this is Regulated Activity (new definition). Requires enhanced CRB + appropriate barred list checkYes, if there is direct contact *YES/NOHRCResearcher provides personal care to *Adults/Children Or Researcher is a social care worker providing social work which is required in connection with any health care or social services to an adult who is a client or potential clientYes, enhancedYes, if done once this is Regulated Activity (new definition). Requires enhanced CRB + appropriate barred list checkYes, if there is direct contact *YES/NO HRCResearcher undertakes the following activities unsupervised: teach, train, instruct, care for or supervise children or provide advice/guidance on wellbeing or drive a vehicle only for children with likely direct bearing on the quality of care6Yes, enhancedYes, if done regularly this is Regulated Activity. Requires enhanced CRB + Childrens barred list check requiredYes, if there is direct contact* YES/NOHRCResearcher has opportunity for any form of contact with children in a Childrens hospital but is not providing healthcare or other types of regulated activity and has no direct bearing on the quality of careYes, enhancedYes, if done regularly enhanced CRB (pre-Sept 2012 definition). No barred list check.Yes, if there is direct contact* YES/NOLoAResearcher has access to persons in receipt of healthcare services in the course of their normal duties but is not providing health care or other types of regulated activity and has no direct bearing on the quality of care (Access relates to where individuals will have physical, direct contact with patients e.g. observation, qualitative interviews, focus groups)Yes, standardNoYes, if there is direct contact* YES/NOLoAResearcher has indirect contact with patients or service users but is not providing healthcare or other types of regulated activity and has no direct bearing on the quality of care (e.g. some types of telephone interview)NoNoNoLoAResearcher requires access to identifiable patient data derived from health records, tissues or organs with a likely direct bearing on the quality of careNoNoYes if working with tissues or organs* YES/NO HRCResearcher requires access to identifiable patient data derived from health records, tissues or organs with no direct bearing on the quality of careNoNoYes if working with tissues or organs* YES/NOLoAResearcher requires access to anonymised patient data derived from health records, tissues or organs* only (including research staff analysing data) (8)NoNoYes if working with tissues or organs* YES/NOLoA (if in NHS facilities)Researcher is working on NHS premises (e.g. laboratory) (no access to identifiable data)NoNoYes if working with tissues or organs* YES/NOLoA (if in NHS facilities)Researcher requires direct contact with staff only but no access to patients e.g. staff interviews. State if on NHS premises*NoNoNoLoA (if in NHS facilities)Researcher requires access to identifiable staff data only. State if on NHS premises*NoNoNoLoA (if in NHS facilities)Researcher requires access to anonymised staff data only. State if on NHS premises*NoNoNoLoA (if in NHS facilities) 3 Please refer to http://www.crb.homeoffice.gov.uk/guidance/rb_guidance/eligible_posts.aspx for guidance on specific activities which are eligible for CRB checks. 4 health care professional means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002. 5 Health care includes all forms of health care provided for individuals, whether relating to physical or mental health and also includes palliative care and procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition. 6 A direct bearing on the quality of care suggests that the actions of researchers could foreseeably directly affect the type, quality or extent of prevention, diagnosis or treatment of illness or foreseeably cause injury or loss to an individual to whom the organisation has a duty of care.     February 2020 Assessment form for Indemnity Arrangements with NHS Please attach copy of this form to the post approval/RSA form, where research is to be undertaken in/with the NHS. Where it is identified that an NHS Honorary Research Contract or Letter of Access is required the postholder will be required to obtain a Research Passport. (Contact Lesley Clissold 0116 252 5154 for further details.)  -I`      9 : ^ _   ( ) . > ? L ¶߉uhEh|FCJaJh|FCJH*aJhmh|FCJaJhmh|F5CJH*aJh|F5CJH*aJh|F5CJaJhmh|F5CJaJh\10h05h05CJaJh\10h05CJaJh\10h|F5h\10h|F5CJaJh{gh{g5CJaJ. -I`vhd$Ifgd@lkd$$Ifl4J@;`; t0;44 layt{gdh$Ifgd-Rdh$Ifgd{g d$Ifgd0lkd$$Ifl4x@; ; t0;44 layt{g 9 : _ xjxxd$IfgdSd$Ifgdmd$Ifgd@kkd$$Ifl@;; t0;44 layt0 ? 7)d$Ifgdmkd$$Iflֈ]Y*d2_7@;J  t0;44 layt0? 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