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SCIENTIFIC RESEARCH APPLICATION

RESEARCH AND WORKPLACE INNOVATION PROGRAM

SCIENTIFIC RESEARCH APPLICATION

RESEARCH AND WORKPLACE INNOVATION PROGRAM

2015

Funding occupational health research and innovative workplace solutions

CLOSING DATE

MAY 11, 2015

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SCIENTIFIC RESEARCH APPLICATION RWIP 2015

Administrative Requirements

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 Re-submission

2. Please let us know how you became aware of the Research and Workplace Innovation Program (RWIP) and the annual call for applications? Please indicate below the source (s) of your information for example: Winnipeg Free Press advertisement, other WCB communications, other Manitoba newspapers; newsletters/communications from labour, employer or safety organizations, University research communications, email or letters from the WCB on the call for RWIP applications, word of mouth, any other source.

It is very important to take note of the following:

3. Please submit this application as a Word document in 14 point font. Applications should not be sent in PDF or other formats.

4. There are six (6) parts to this application. Please ensure that you have provided all the information required in each part before you submit your application. A checklist to assist you is below:

CHECKLIST - Show an X for each completed sectionPart 1: General Information Part 3: Management of ProjectPart 2: Research Proposal Part 4: Risk Assessment2.1 Literature review Part 5: Project Budget2.2 Relevance and Significance Part 6: Research Team Information2.3 Research objectives2.4 Research Design and Methodology2.5 Data Analysis2.6 Scope of Research2.7 Knowledge Transfer & Exchange

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PART 1: GENERAL INFORMATION

1.1 PROJECT TITLE

1.2 PRINCIPAL APPLICANT/S

NameTitleHost InstitutionBusiness Mailing AddressTelephone NumberEmailOther contact informationSignatureDateIf there is more than one principal applicant provide information as above

1.3 CO- APPLICANT/S

NameTitleHost InstitutionBusiness Mailing AddressTelephone NumberEmailOther contact informationSignatureDate

If there is more than one co-applicant provide information as above

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1.4 HEAD OF DEPARTMENT/RESEARCH ORGANIZATION

NameTitleHost Institution/OrganizationBusiness Mailing AddressTelephone NumberEmailOther contact informationSignatureDate

Where Applicable

1.5 INFORMATION OF FINANCIAL OFFICER WHO WILL MANAGE GRANT FUNDS

NameTitleHost Institution/OrganizationBusiness Mailing AddressTelephone NumberEmailOther contact informationSignature

Date

1.6 SUMMARY OF SCIENTIFIC RESEARCH PROPOSAL

Please provide a summary of the research proposal that includes the following: i. A brief description of the study to include the research question, issue or

problem, how the study will address it and how the study will be doneii. The relevance to the WCB and fit with mandate of the Research and

Workplace Innovation Programiii. Steps to transfer research findings to end usersiv. Funding amount requestedv. Duration of study

Should not exceed two (2) pages

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1.7 IF THIS IS A RE-SUBMISSION OF A PROPOSAL

If this proposed study is a re-submission of an earlier one please provide a response to the comments and critiques of the WCB. In the case of scientific research applications, the WCB's comments would have included the evaluation from peer reviewers. The applicant should indicate how the re-submitted application is revised based on the feedback provided by the WCB in its letter informing the applicant about the status of his or her previous application.

Should not exceed one page

PART 2: RESEARCH PROPOSAL

2.1 LITERATURE REVIEW OF EXISTING KNOWLEDGE

The review of existing knowledge in the proposed study area/s should at a minimum include the following:

i. A description of leading research and data in the body of knowledge encompassing the proposed area/s of study;

ii. An analysis of the relative strengths, weaknesses, limitations and gaps in knowledge relative to the proposed study area/s; and

iii. A discussion of key completed studies and on-going research in the Canadian context such as research by workers compensation boards, academic institutions, research organizations and other researchers which relate to this study.

2.2 RELEVANCE AND SIGNIFICANCE OF RESEARCH

i. Explain why the proposed research would be different from the information in 2.1 above;

ii. Identify the central issues and/or problems the proposed research would be addressing and explain why this is important to Manitoba; and

iii. Describe the theoretical and practical significance of the proposed research including a description of how the proposed study would fill gaps in knowledge, policy, programs or practices for workers compensation.

2.3 RESEARCH OBJECTIVES

i. Specify clearly the objectives of the research; andii. Provide the rational for the research objectives.

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2.4 RESEARCH DESIGN AND METHODOLOGY

Please provide a clear explanation of the theoretical/conceptual framework guiding the research. Your explanation should at a minimum include:

i. Key concepts and definitions;ii. Rationale for selection of theoretical framework;

iii. Research methodology; andiv. Sample Information: description, estimated size, etc. and sources that will

provide the basis for selection of sample.

If you plan to use proven research instruments please attach copies.

2.5 DATA ANALYSIS

i. Indicate if your study will require data from the WCB or Workplace Safety and Health Division, Manitoba Labour and Immigration.

ii. Identify data sources; iii. Describe the method/s and software requirements;iv. Describe the types of data that will address research objectives and issues;

andv. Indicate if methodology needs approval of an ethics review board and

whether the study involves any of the following:

a) Human subjects;b) Stem cells;c) Vertebrate animals;d) Biological research hazards; ande) An environmental impact or assessment.

2.6 SCOPE OF RESEARCH

i. State what the study will address and areas that will not be covered by study;

ii. Explain the linkage between the scope of the study relative to the budget request; and

iii. Describe how the study's scope anticipates successful completion within the proposed project's duration.

2.7 KNOWLEDGE TRANSFER and EXCHANGE

Please clarify the expected outcomes of the research and provide a description of the knowledge transfer and exchange planned during the study and after the study is completed. The knowledge transfer and exchange planned for the study is related to the relevance and applicability of the study's final results. It is important to the WCB

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that the study's results and outcomes are actively shared with key user groups, potential audiences, practitioners in the occupational health and safety community and the academic community. See Section 3.5 of the Applicant Information for more information on knowledge transfer and exchange.

Include the estimated cost for knowledge transfer and information sharing in the project's budget. See Part 5 of this application and Section 7.6 of the Applicant Information for more information on the budget requirements.

PART 3: MANAGEMENT OF PROJECT

Please provide a timetable and work plan that will:

i. Identify and describe project activities; ii. Specify key milestones;

iii. Identify start and finish dates; and iv. Relate costs to project activities.

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


PART 4: RISK ASSESSMENT

Identify the potential risks to successful completion of the project, e.g. cooperation from workplace parties, participation of subjects, resource availability etc.

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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


PART 5: PROJECT BUDGET

5.1 EXPLANATION OF BUDGET AND JUSTIFICATION OF BUDGET ITEMS1

Use the format below to assist you in completing the budget.

The WCB will provide support for the direct costs of the project [including project assistance, support for technical, professional and secretarial services, equipment (purchase or rental), project-related travel and supplies].

Project costs may include reasonable administrative costs, but should not include costs of salary replacement for staff involved in project, buy-outs of teaching time or other responsibilities of the applicant/s, co-applicant/s or the study's partners.

Applicants must also demonstrate that the WCB grant and/or any financing from other sources will provide adequate financial support to achieve the objectives of the proposal.

Please take note that the WCB is GST exempt.

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BUDGET ITEMS AND JUSTIFICATION

Year 1 Year 2 Total

Budget Item WCB $ Request

WCB $ Request

WCB $Request Justification of Funds

1 Salaries, Benefits/Consultancy fees2. (Specify for each of project team)

Sub-Total2 Material and supplies

(list each item greater than $1,000)

Subtotal3 Equipment

(purchase, rental, lease)

Subtotal4 Knowledge Transfer

Subtotal5 Travel,

accommodation and meals3

Subtotal6 Other costs (specify

by item; for example stipends paid to individuals in sample

SubtotalTotal WCB Funding

Request (sum of items 1 to 6)

Specific project costs met by the employer ( in-kind)

Subtotal Include all items essential for the conduct of the project. Provide a brief, clear justification for each budget item and relate it to the objectives and requirements of the proposed research. The budget quantifies the timetable and work plan in terms of personnel, materials, supplies, and other requirements. Accordingly, it is essential that the link between the research proposal and the budget be clear.2 Applies for new staff or consultants hired to work on the project. It should not include salaries or benefits of current employees participating or involved in the project.

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3 Any cost of transportation, accommodation and meals paid according to WCB Manitoba rates. Estimate the number of days, transportation, accommodation and meal costs by number of persons and number of days. WCB Manitoba rates are available at the end of this application.

PART 6: RESEARCH TEAM INFORMATION

6.1. BIOGRAPHICAL SKETCH OF PRINCIPAL APPLICANT, CO-APPLICANT/S AND OTHER TEAM MEMBERS

Each biographical sketch:i. must be part of the electronic application form;

ii. may not be longer than 5 pages; and iii. include the following elements:

o full name and title;o institution or organization;o educational background (institution, degree/diploma,

certificate/qualification conferred, year conferred, and field of study);o research and professional experience; o publications, ando funding applied for and received.

FORMAT FOR BIOGRAPHICAL SKETCH

Name, Title, Contact Information

Surname Given Name, Initials Title (Dr., Mr., Ms., Other)

Institution/Organization

Educational Background

Institution and location Degree/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)

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WCB TRAVEL, ACCOMMODATION AND MEAL RATES

Mileage Rates Project staff will be entitled to the mileage rate set by the WCB. The rate is updated every six months. The rate as of January 2015, is $0.37 per kilometer.

Air TravelProject staff should take advantage of discount fares, hotel rates and use Economy Class of air service.

ACCOMMODATION o A standard hotel room is to be used on business travel. Depending on the

availability, you should choose a hotel close to the site where business will be conducted as this usually limits the need for a rental car.

o Original receipts must accompany claims for accommodation and other expenses.

o All bills for accommodation must be signed except if you stay with friends or relatives.

o Reimbursement made for gifts in the form of food, drink or related items, will not exceed 80% of the cost that otherwise would have been incurred.

o The WCB will not reimburse the cost of a spouse or second party who accompanies you.

MEAL RATES

2015 Meal Rates Workers Compensation Board of Manitoba*Meal Expense Allowances:Inside Manitoba CPI (2002=100)Manitoba Meal Rates January, 2015Breakfast $10.00Lunch $13.60Dinner $26.55Total $50.15Note: For day trips, receipts not required

Out of town, overnight in Manitoba Article 19.10 (b) January, 2015Departure before 0900 hours (breakfast, lunch & dinner)

$50.15

Departure after 0900 hours but before 1400 hours $40.15

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(lunch & dinner)Departure after 1400 hours (dinner only) $26.55Return before 0900 hours (breakfast only) $10.00Return after 0900 hours but before 1400 hours (breakfast & lunch)

$23.60

Return after 1400 hours (breakfast, lunch & dinner) $50.15

Outside of ManitobaCPI (2002=100)Outside Manitoba Meal Rates; January, 2015Breakfast $13.25Lunch $17.90Dinner $35.45Total $66.60Note: For day trips, receipts not required

Out of town overnight expenses January, 2015Departure before 0900 hours (breakfast, lunch & dinner)

$66.60

Departure after 0900 hours but before 1400 hours (lunch & dinner)

$53.35

Departure after 1400 hours (dinner only) $35.45Return before 0900 hours (breakfast only) $13.25Return after 0900 hours but before 1400 hours (breakfast & lunch)

$31.15

Return after 1400 hours (breakfast, lunch & dinner) $66.60

*Effective from January, 2015

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