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EVALUATION CRITERIA
COURSE (PLEASE SELECT ONE) STUDENT #:
LEVEL (PLEASE CHECK ONE) LEVEL 2 LEVEL 3 LEVEL 4
PROGRAM (SELECT ONE) CORE CHS GHS BMS OTHER
SUPERVISOR INFORMATION PRIMARY SUPERVISOR NAME:
SUPERVISOR EMAIL:
SUPERVISOR AFFILIATION & ADDRESS:
SUPERVISOR PHONE:
PROJECT LOCATION: Library only On campus
PROJECT TITLE & TOPIC AREA:
PROJECT START DATE: PROJECT END DATE:
EVALUATION CRITERIA *INCLUDE % BREAKDOWN (BE SPECIFIC, INDICATE WHO IS EVALUATING EACH COMPONENT) **NOTE: A self evaluation MUST be included in the evaluation criteria (1 page written reflection). The supervisor MUST review this with the student upon final evaluation and SIGN the page. THIS IS A MANDATORY COMPONENT, AND WILL NOT CONTRIBUTE TO THE FINAL GRADE.
Evaluation Criteria Evaluated by Weight/100% Self-Evaluation (required - must be reviewed and signed by supervisor) 0
BHSc (Honours) PROJECT FORM*Due at least 2 weeks prior to start of project **PRINT/ SAVE A COPY OF THESE FORMS FOR YOUR RECORDS
STUDENT EMAIL:
ADDITIONAL SUPERVISOR(S) (if applicable):
TERM:
Last Name
Off campus
YEAR:
STUDENT NAME:
First Name
Last NameFirst Name
Register for term in which project will be complete
Supervisor Department
Supervisor Institution
Supervisor Position
Supervisor Address
Project Title
Project Topic Area
Must be 9 digits
Total:
*You must use Adobe Acrobat Reader DC to complete and submit this form. You cannot use a browser.
*MUST total 100%
PROJECT TITLE, OUTLINE & LEARNING OBJECTIVESTITLE OF PROJECT:
STUDENT:
I confirm that this student is committing to a minimum of 100 hours of work for this 3 unit project course (HTH SCI 3H03/3BM3/4D03/4W03)
I confirm that this student is committing to a minimum of 200 hours of work for this 6 unit project course (HTH SCI 3H06/3BM6)
Supervisor must confirm time commitment for this project course
BHSc Safety Education Training Record
ADDITIONAL TRAINING *AS ADVISED BY SUPERVISOR (PLEASE SPECIFY) e.g. BUILDING SPECIFIC TRAINING, BIOSAFETY, IMMUNIZATION REQUIREMENTS, SPECIALIZED EQUIPMENT TRAINING DATE
SAFETY TRAINING (MOSAIC course code) DATE SAFETY TRAINING (MOSAIC course code) DATE Accessibility (AODA) Chemical Handling and Spills (CHEMHS)Public Health Ontario (FHSPHO) Health and Safety Orientation (HSORI)FHS N95 Respirator (FHSN95) Ergonomics (ERGON)FHS Code Awareness (FHSCDA) Violence and Harassment Prevention (VHPW)
Asbestos Awareness (ASBEST) Slips, Trips and Falls (SLPTRP) WHMIS 2015 (WHMS15)
DATE FHS Hospital Fire Safety (FHSFSF) If project is located at McMaster Hospital or off-campus. Must be updated annually.
Fire Safety (FIRETR) If project is located on campus. Must be updated annually.
NOTES:Off campus project courses require the completion of the Risk Management Manual (RMM) program #801 Field Trip/Student Placement/Research Activity Approval form. This form can be found on page 11 of the RMM #801 program at:
http://www.workingatmcmaster.ca/med/document/RMM-801-Field-Trips-Student-Placements-and-Research-Activity-Planning-and-Approval-Program-1-36.pdf
Full details regarding training requirements for your specific project course work and project location, as well as forms required for travel off-campus, can be found at:
http://www.learnlink.mcmaster.ca/docs/Requirements.pdf
FIRE SAFETY TRAINING (you must complete AT LEAST ONE of the Fire Safety courses below)
Please note: ALL fields must contain a date. Please enter the date training was taken or is planned to be taken. If a safety training course does not apply to you, please use 05-Sep-2000 instead (copy/paste this date).
ETHICS SCREENING AS A STUDENT AND REPRESENTATIVE OF THE BACHELOR OF HEALTH SCIENCES (HONOURS) PROGRAM, WE EXPECT THAT YOU WILL CONDUCT YOURSELF IN A RESPECTFUL AND ETHICAL MANNER AT ALL TIMES AND TO ALL BEINGS. All research activities, conducted by students, faculty and staff under the auspices of the Bachelor of Health Sciences (Honours) Program, are to comply in spirit as well as in fact with the Tri-Council Policy for Research Ethics, the Animal Utilization Protocol (AUP) and the Canadian Biosafety Standards and Guidelines of the Public Health Agency of Canada (PHAC).
Every student conducting any projects within the program must complete Research Ethics Screening prior to beginning their project since it is often difficult to determine the line between research and non-research activities. Completing this form is a learning opportunity for the student and not solely an administrative requirement.
If your project supervisor already knows that your project requires HiREB approval that has not yet been completed, you may submit these forms simultaneously to both the BHSc Office and HiREB and indicate that the application is pending approval.
Title of Project:Supervisor:Department: Institution:
NO
Name of Board: REB/AUP/BIOHAZARD Number: Title of REB approved project: Principal Investigator on approval: Date of last renewal:
YES
YES NO
NO
NO
Does this project extend beyond Library Research? If NO, please skip the remaining questions on this page
Will you be conducting research that in any way involves human participants?If Yes, plese explain:
Will you be conducting research that in any way involves animals?If Yes, plese explain:
Has your supervisor received Research Ethics Approval for the research project described?
Please identify WHICH ethics board approved the project and provide the approval number:
PENDING
YES
YES
Notice of Collection:The information gathered on this form is collected under the authority of The McMaster University Act, 1976. The information is used for the academic, administrative, and statistical purposes of the Faculty of Health Sciences BHSc Program including, but not limited to, maintaining records; academic counselling and the administration of examinations. Personal student information provided on this form will not be used for any unrelated purpose without the consent of the student. This information is protected and is being collected pursuant to section 39(2) and section 42 of the Freedom of Information and Protection of Privacy Act of Ontario (RSO 1990). Questions regarding the collection or use of this personal information should be directed to the Associate or Assistant Dean, Faculty of Health Sciences BHSc Program, McMaster University.
STEP 2(student)
STEP 3
SUBMISSION
STEP 1(student)
(supervisor)
Please save this file to your computer by clicking the button to the right. The filename must include the course code and and the student's first and last names, such as: coursecode_lastname_firstname.pdf (e.g. 3H03_Ritz_Stacey.pdf). Once the file has been saved, proceed to Step 2.
By clicking this box, I confirm that the information in this form is accurate and to the best of my knowledge. Any changes made to the content of this form throughout the duration of my project course will be brought to the attention of the BHSc Office via email. Once confirmed, click on the green submit button to send to your supervisor for approval.
By clicking this box, I confirm that I have reviewed and approved the project course content, and I agree to supervise the student for the above described project course. Once confirmed, click on the red submit button to submit this form to the BHSc office for review. Electronic submission of this HTH SCI project course form is done in lieu of a signature. By submitting this form, you are confirming approval of the project course content, evaluation criteria, and ethics requirements.
PLEASE NOTE:
If clicking the send button in step 2 does not automatically open an email with the form attached, please send it as an attachment to your supervisorand cc to this address:
If clicking the send button in step 3 does not automatically open an email with the form attached, please send it as an attachment to:
Last saved:v1.4
OFFICE USE ONLY
Ethics Review:
Forms Review:
DATE OF REVIEW REVIEW NOTES (select option of enter custom text)
