€¦ · Web viewPROJECT TITLE: PROJECT TITLE: Scientific Research Application RWIP 2017. 1. RWIP 2017 Scientific Research Application 2. Scientific Research Application RWIP 2017

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


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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


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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


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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


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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


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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.


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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.


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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)


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Documents

€¦ · Web viewPROJECT TITLE: PROJECT TITLE: Scientific Research Application RWIP 2017. 1. RWIP 2017 Scientific Research Application 2. Scientific Research Application RWIP 2017