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SmART-Form Interest Survey - National

Survey Consent Form

This is a voluntary survey in which you do not have to participate. Please read the consent form below and click "agree" if you would like to participate. Please do note that no personal information is required. Thank you! 
1. On a scale of 1 to 10, how concerned are you about the air quality (in general, or any specific contaminant) in the following locations?
Space Cell Not Concerned (1)23456789Extremely Concerned (10)
The air in your home (indoor)
The air in your workplace (indoor)
Outdoor air
The air near a local industry (outdoor)
2. If you have concerns, which of these contaminants (if any) are you concerned about? (select all that apply)
This is a survey about air quality concerns in general and formaldehyde more specifically.
4. The purpose of this research project is to develop a low-cost and highly accurate technique for assessing domestic formaldehyde concentrations and is being conducted by Ohio State University in conjunction with the Public Laboratory for Open Technology and Science (Public Lab). Insights from citizen scientists and other relevant members of the public is key to developing the most robust and useable technology possible.
 
You are invited to participate in this research project because you are either (or both):
  1. A member of an environmental or citizen science organization, or are interested in citizen science or local environmental issues.
  2. A resident of or near Waycross, GA where the technology developed by this project will be first deployed.
Your participation in this research study is voluntary. You may choose not to participate. If you decide to participate in this research survey, you may withdraw at any time. If you decide not to participate in this study or if you withdraw from participating at any time, there will be no penalty or loss of benefits that the participant is entitled to. You may skip any questions you do not wish to answer. If you want do not wish to complete this survey just close your browser.

The procedure involves filling an online survey that will take approximately 5-10 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address or IP address. The survey questions will be about your interest in testing for airborne formaldehyde, how we should build the software and hardware for this technology to best suit your needs, and reflections on past community science studies (if applicable).

We will work to make sure that no one sees your survey responses without approval. But, because we are using the Internet, there is a chance that someone could access your online responses without permission. In some cases, this information could be used to identify you. Your data will be protected with a code to reduce the risk that other people can view the responses. We will do our best to keep your information confidential. All data is stored in a password protected electronic format. To help protect your confidentiality, the surveys will not contain information that will personally identify you. The results of this study will be used for scholarly, technical development, public education purposes only and may be shared with Ohio State University representatives.

For questions, concerns, or complaints about the study, or you feel you have been harmed as a result of study participation, you may contact Karen Dannemiller at 614-292-4031.
For questions about your rights as a participant in this study or to discuss other study-related concerns or complaints with someone who is not part of the research team, you may contact Ms. Sandra Meadows in the Office of Responsible Research Practices at 1-800-678-6251.This research has been reviewed according to Ohio State University IRB procedures for research involving human subjects.

 
Please print a copy of this consent form for your records, if you so desire. 
 
 
ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that: 

• you have ready the above information
• you voluntarily agree to participate
• you are at least 18 years of age 

If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button.

  *This question is required.
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