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Transcript of Please refer to Section 2.16 Part 4 of the Applicant ... Web viewWord of mouth. RWIP brochure....
SCIENTIFIC RESEARCH APPLICATION
RESEARCH AND WORKPLACE INNOVATION PROGRAM 2017
Funding Occupational Health Research, Training and Education and Innovative Workplace Solutions
CLOSING DATE
May 18, 2017
PROJECT TITLE:
Administrative Requirements
Please refer to Sections 2.15 to Section 2.25 of the Applicant Information Document and use this template to complete your Scientific Research Application.
Please provide the information for questions 1 and 2 below. 1. Indicate if this is an initial application or re-submission of a previous
application. Please mark the appropriate box with an X.
Initial Application Resubmission
2. Please let us know how you became aware of the Research and Workplace Innovation Program (RWIP) and the annual call for applications. Please mark the appropriate box with an X.
WCB websiteWCB letterWCB emailNewspaper AdvertisementOther WCB communicationsWord of mouthRWIP brochureUniversity communications or newslettersOther, please specify
CHECKLIST - Show an X for each completed sectionPart 1: General Information 2.7 Knowledge Transfer &
ExchangePart 2: Research Proposal Part 3: Management of Project2.1 Literature review Part 4: Risk Assessment2.2 Relevance and Significance Part 5: Project Budget2.3 Research objectives Part 6: Research Team Information2.4 Research Design and Methodology2.5 Data Analysis2.6 Scope of Research
PART 1: GENERAL INFORMATION
Scientific Research Application RWIP 2017
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PROJECT TITLE:
1.1 PROJECT TITLE
Type here
1.2 PRIORITY AREA: Please mark the appropriate box with an X
A. Comparative Analysis of WCB Retrospective Data to Determine the Efficacy of Healthcare Usage and Treatment Modalities for Optimal Return To Work Outcomes
B. Assessment, Screening, Monitoring and Control of Physical, Chemical and Biological Exposure Agents in the Workplace
C. Early Detection, Diagnosis and Treatment of Occupational Disease from a Prevention Lens
D. Other Topics within RWIP Mandate
For a more detailed description of the Research Priorities refer to Sections 2.2 to 2.3 of the Applicant Information Document
NB: The priority area in the Scientific Research Application should be the same as the priority area selected in the Notice of Intent
1.3 PRINCIPAL APPLICANT/S
NameTitleHost InstitutionBusiness Mailing AddressTelephone NumberEmailOther Contact InformationSignatureDate
If there is more than one principal applicant provide information as above
1.4 CO- APPLICANT/S
Scientific Research Application RWIP 2017
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PROJECT TITLE:
NameTitleHost InstitutionBusiness Mailing AddressTelephone NumberEmailOther Contact InformationSignatureDate
If there is more than one co-applicant provide information as above.
1.5 APPROVAL BY HEAD OF ACADEMIC DEPARTMENT/RESEARCH ORGANIZATION
NameTitleHost Institution/OrganizationBusiness Mailing AddressTelephone NumberEmailOther Contact informationSignatureDate
Where Applicable
1.6 INFORMATION OF FINANCIAL OFFICER WHO WILL MANAGE GRANT FUNDS
NameTitleHost Institution/OrganizationBusiness Mailing AddressTelephone NumberEmailOther Contact information
Scientific Research Application RWIP 2017
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PROJECT TITLE:
SignatureDate
1.7 SUMMARY OF SCIENTIFIC RESEARCH PROPOSAL Should not exceed two (2) pages
Please refer to Section 2.16 Part I of the Applicant Information Document
Type here
1.8 IF THIS IS A RESUBMISSION OF A PROPOSAL Should not exceed one page
Please refer to Section 2.16 Part I of the Applicant Information Document
Type here
PART 2: RESEARCH PROPOSAL
Please refer to Section 2.16 Part 2 of the Applicant Information Document
Type here
2.1 LITERATURE REVIEW OF EXISTING KNOWLEDGE
Please refer to Section 2.16 Part 2 a)
Type here
2.2 RELEVANCE AND SIGNIFICANCE OF RESEARCH
Please refer to Section 2.16 Part 2 b)
Type here
2.3 RESEARCH OBJECTIVES
Please refer to Section 2.16 Part 2 c)
Type here
2.4 RESEARCH DESIGN AND METHODOLOGY
Scientific Research Application RWIP 2017
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PROJECT TITLE:
Please refer to Section 2.16 Part 2 d) of the Applicant Information Document
Type here
2.5 DATA ANALYSIS
Please refer to Section 2.16 Part 2 e) of the Applicant Information Document
Type here
2.6 SCOPE OF RESEARCH
Please refer to Section 2.16 Part 2 f) of the Applicant Information Document
Type here
2.7 KNOWLEDGE TRANSFER and EXCHANGE (KTE)
Please refer to Section 2.16 Part 2 g), Section 5 and Section 6.9 of the Applicant Information Document.
Type here
PART 3: MANAGEMENT OF PROJECT
Please refer to Section 2.16 Part 3 of the Applicant Information Document
Please use the format below. Activities should be listed in sequence, indicating related activities and dependencies for successful completion.
TIMETABLE OF KEY PROJECT ACTIVITIES
Specify Key Project Milestones Start Date Completion Date
EstimatedCost
Add rows as needed
Should not exceed one page
PART 4: RISK ASSESSMENT
Scientific Research Application RWIP 2017
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PROJECT TITLE:
Please refer to Section 2.16 Part 4 of the Applicant Information DocumentPlease use the Risk Assessment Matrix below to describe the risks and potential solutions to mitigate the risks identified.
RISK ASSESSMENT
Describe Potential Risk Event
Assess Risk Likelihood Estimate Impact Strategy/Plan to Mitigate
RisksUse a single row for each potential risk identified
Use specific project objectives, milestones, activities or deliverables to identify risk events.
Select one response from the list below for each risk identified:
-Very Likely-Probable-Very Unlikely
Select one response from the list below for each risk identified:
-High-Medium-Low
Describe the strategy or plan for each risk identified
Should not exceed one page
PART 5: PROJECT BUDGET: EXPLANATION OF BUDGET AND JUSTIFICATION OF BUDGET ITEMS
Please refer to Section 2.16 Part 5 and Section 6 of the Applicant Information Document
Use the Table below to assist you in completing the budget.
Year 1 Year 2 Total
Budget Item WCB $ Request
WCB $ Request
WCB $ Request
1 Salaries Insert rows as needed
Benefits costsConsultancy feesOther remuneration
Sub-Total
2Material and supplies (list each item greater than $1,000) Insert rows as needed
Scientific Research Application RWIP 2017
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PROJECT TITLE:
Year 1 Year 2 TotalSubtotal
3 Equipment purchase Insert rows as neededEquipment rentalEquipment lease
Subtotal 4 KTE Planning costs Insert rows as needed
KTE Stakeholder engagementProject Advisory CommitteeKTE Meeting costsKTE Presentation costsKTE Publication costsOther KTE dissemination costs
Subtotal
5 Travel, accommodation and meals3 Itemize each expense
Subtotal
6 Other costs specify by item Insert rows as
needed
Stipends paid to participantsMeal allowances etc.
SubtotalTotal WCB Funding Request
Specific project costs met by the employer ( in-kind) Itemize
SubtotalUse the list below to assist you in developing your budget line items.
Justification of Budget Expenditures
You are required to provide a description of each budget expenditure item.
Scientific Research Application RWIP 2017
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PROJECT TITLE:
1 Salaries, Benefits and Consultancy Fees
Number of staffing positions
Brief description of the roles and responsibilities of each position
Employment status of the position e.g. whether it is full time or part time
Estimated number of working hours Pay rate e.g. whether hourly/weekly/monthly
Brief description of description of qualifications
Other information
2 Materials and Supplies
Cost office supplies, photocopying, printing, telephone, fax, conference calls, consumables, printer supplies
List items or supplies that exceed $1,000.00
3 Equipment
Purchase, lease or rental of such as
Tools, machinery or vehicles;
Software licences and licensing fees
Fees to access databases or research material
Instruments for testing and for experiments
Desktop or laptop computers, tablets
Portable data collection equipment Scientific Research Application RWIP 2017
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PROJECT TITLE:
4 Knowledge Transfer and Exchange (KTE)
Costs of setting up a Project Advisory Committee (PAC)
Meeting costs for the PAC
Costs of other stakeholder engagement
Costs for publication in peer reviewed journals
Costs of materials for dissemination of project resources
Costs of travel, meals and accommodation for presentations
Other resources to promote KTE
5 Travel, Accommodation and Meals
Transportation
Accommodation
Meals
Please refer to Section 11 of the Applicant Information Document for estimating travel, accommodation and meal costs for Part 5 of the application templates.
6 Other Project Costs
Payment of stipends
Payment of honoraria to participants
Other items not referenced in budget expenditure items 1 to 6.
Scientific Research Application RWIP 2017
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PROJECT TITLE:
PART 6: RESEARCH TEAM INFORMATION
Please refer to Section 2.16 Part 6 of the Applicant Information Document. Please use the format below.
FORMAT FOR BIOGRAPHICAL SKETCH
Name, Title, Contact Information
Surname Given Name, Initials Title (Dr., Mr., Ms., Other)
Institution/Organization
Educational Background
Institution and locationDegree/Diploma/Certificate/Qualification
Year Field of study
Research and Relevant Professional Experience
In chronological order, list previous employment, experience and honours, concluding with current position held
List all publications for the last 5 years which relate to this research proposal
Funding Applied for and Received ( over the last 5 years)
Scientific Research Application RWIP 2017
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