Ambulance Victoria General Portal

Informed Consent

The quality of this project depends on your willing participation so you are assured of confidentiality with your data stored on STAGE-28’s encrypted servers. STAGE-28 is an organisation committed to high-quality research to benefit emergency service personnel so its security measures will deny access to any colleague, manager or organisation you may be associated with. Your e-mail address will be retained at STAGE-28 to send information regarding your mental health as revealed by your scores.

There are two portals:

1. A ‘general’ mental health and wellbeing portal completed at the start and end of the project, and

2. An ‘incident’ portal completed after certain critical incidents and again 1-3 days later.
If you wish to withdraw at any time let us know and your data will be traced and deleted. Contact details, research information and how to raise concerns appear on the final page, where you submit this form. Your consent is assumed for the six months this project is expected to run. An information sheet we recommend you read can be downloaded here: Information Sheet.

Please tick this box to say you give your consent. *

Please tick this box to say you give your consent.

Email address: *

Code/ID: *

Two initials plus 4-digit birthday and month For example: for Joe Smith born 24/08/77 enter: ‘JS2408’

Age: *

Gender Identity: *

Male

Female

Other (type in box if you wish)Other (type in box if you wish)

Current status: *

Married/De Facto

Single

Separated/Divorced

OtherOther

Position: *

Time in Role: *

YY/MM

If a situation, person or incident often upsets or distracts you, who or what would that be?

If you could change one thing about being a paramedic at AV, what would that be?

Please read the questions that follow carefully. Then answer by clicking on the appropriate radio-button. Anything you would like to tell us you can type here, or at the end