IGO SDHS Request Form (Dev) - Clinical School Computing Service

Contact Details

Data description

Use of data during the study

People

At the end of the research

Additional information

Approvals

Name of Study:*
Chief Investigator (CI)*
Prefix First Last
Planned Study End Date
Please use the date picker to confirm when the research is due to be completed;*
DD slash MM slash YYYY
Approved Study Data Managers (DM)*
Approved Study Data Managers (DM):*
*The Clinical School expects Data Managers to have completed the UIS Cyber Security Training and the University Data Protection Training Module . Please add all data managers applicable to the study. If there is more than one, select the ‘+’ icon to add a new row;
Full name: CRSID (Raven username): Data Training Completed? * Date of training (if applicable)
Other users requiring access to the SDHS study data
Please add the details of all additional users (other than the Data Managers named above) who will be accessing during the study. If there is more than one, select the ‘+’ icon to add a new row;
Full name: CRSID (Raven username): Data Training Completed? * Date of training (if applicable)
Designated Point of Contact
Please advise who should be contacted if there are queries pertaining to this request*
Prefix First Last
Contact Email*
Enter Email Confirm Email
Contact phone number
Name of person completing this request if different to above
Name of person completing this request if different to above
First Last Role of person completing request

Save and Continue Later

Please answer the following questions to help us confirm that the Secure Data Hosting Service provides a suitable environment for the requirements of the study;
1. Is this a request to store sensitive personal data for a new research proposal or a change to an existing research proposal to extend the original data storage requirements?*
2. Have you already produced a data management plan?*
Please upload a copy of the plan here*
(doc, docx, docm, pdf, odt, rtf, zip acceptable)
Drop files here or

Accepted file types: doc, docx, docm, pdf, odt, rtf, zip, Max. file size: 8 MB.
Type of Data

3. What type of data do you wish to store?
3a. Text*
Please select ‘Not applicable’ or the Text type(s) you wish to store. If multiple options apply keep selecting until all those that are relevant are listed. If not listed choose ‘other’.
You selected 'other'; Please key in the additional Text type(s) below.*
3b. Images*
Please select ‘Not applicable’ or the Image type(s) you wish to store. If multiple options apply keep selecting until all those that are relevant are listed. If not listed choose ‘other’.
You selected 'other'; Please key in the additional Image type(s) below;*
3c. Audio files*
Please select ‘Not applicable’ or the Audio file type(s) you wish to store. If multiple options apply keep selecting until all those that are relevant are listed. If not listed choose ‘other’.
You selected 'other'; Please key in additional Audio File type(s) below;
3d. Film*
Please select ‘Not applicable’ or the Film type(s) you wish to store. If multiple options apply keep selecting until all those that are relevant are listed. If not listed choose ‘other’.
You selected 'other'; Please key in additional Film type(s) below;*
3e. Other file types
Please record any other data file types you wish to store in the space below.
4. Please provide total data size to be stored*
Data Source
5. Compliance related to the data source
5a. Where is the data you wish to store coming from?*
Please select one or both options as required.
5b. Please confirm the details of the third party/parties who will sending the data, e.g. NHS Digital, Public Health England etc.;*
5c. Is there a Data Transfer Agreement (DTA) / Data Sharing Agreement or other supporting evidence of compliance / rules, in place to cover transfer of data sets between different establishments?
5d. Did the DTA / Data Sharing Agreement originate with a third party, rather than University of Cambridge?
5e. Has the DTA / Data Sharing Agreement been reviewed by the Contracts Team within the Research Office?
6. Are there known compliance requirements (legal or regulatory) related to receiving this data e.g. NHS Toolkit, GDPR etc.*
Please confirm what these are or type ‘none applicable’;
7. How is the data to be transferred and loaded?*
Please provide a brief summary below;

Save and Continue Later

Please upload the following supporting documentation
Research Ethics Committee Approval Letter
Accepted file types: doc, docx, docm, rtf, pdf, Max. file size: 8 MB.
(doc, docx, docm, rtf, pdf (8MB max)
Participant Information Sheet
Accepted file types: doc, docx, docm, rtf, pdf, Max. file size: 8 MB.
(doc, docx, docm, rtf, pdf)
Consent Form
Accepted file types: doc, docx, docm, rtf, pdf, Max. file size: 8 MB.
(doc, docx, docm, rtf, pdf)
Research Ethics Committee Application Form (please only attach pages relating to Data Storage)
Accepted file types: doc, docx, docm, rtf, pdf, Max. file size: 8 MB.
(doc, docx, docm, rtf, pdf)
Is the study a Clinical Trial of Investigational Medicinal Product (CTIMP)?
Is the study a Clinical Trial of Investigational Medicinal Product (CTIMP)?
If yes please provide MHRA approval date and CTA
PLEASE NOTE: NEITHER THE IGO OR CSCS ARE RESPONSIBLE FOR THE DATA CONTENT. THE CHIEF INVESTIGATOR IS RESPONSIBLE FOR ALL CONTENT AND ENSURING THAT ALL REGULATORY REQUIREMENTS FOR THE DATA ARE ADHERED TO.
Confirmation; Reading the policies*
I confirm as Chief Investigator that the Secure Data Hosting Policy and SDHS Acceptable Use Policy have been read and understood by myself, the Data Manager(s) and SDHS users associated with this study. Please tick the box
I confirm as Chief Investigator that the https://www.medschl.cam.ac.uk/research/information-governance/sdhs-security-policy/ Secure Data Hosting Policy and https://www.medschl.cam.ac.uk/research/information-governance/sdhs-acceptable-use-form/ Acceptable Use Policy have been read and understood by myself, the Data Manager(s) and SDHS users associated with this study. Please tick the box
Confirmation; Compliant use of the Secure Data Hosting Service*
I confirm that we agree to use the Secure Data Hosting Service in accordance with these policies. Please tick the box
Chief Investigator Signature
Please upload a saved version of your signature below;
Max. file size: 8 MB.
Date of signing
MM slash DD slash YYYY
For further information please contact;
Research Governance Office, Clinical School, Box 111, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0SP or e-mail; researchgovernance@medschl.cam.ac.uk

Save and Continue Later

Contact Details

Data description

Use of data during the study

People

At the end of the research

Additional information

Approvals

Planned Study End Date

Approved Study Data Managers (DM)*

Other users requiring access to the SDHS study data

Designated Point of Contact

Please answer the following questions to help us confirm that the Secure Data Hosting Service provides a suitable environment for the requirements of the study;

Type of Data

Data Source

8. Extraction of data

9. Data analysis

10. Printing

11. Internet access

12. People

13. Data disposal

For further information please contact;

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Privacy Policy

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Study at Cambridge

Full name:	CRSID (Raven username):	Data Training Completed? *	Date of training (if applicable)

Full name:	CRSID (Raven username):	Data Training Completed? *	Date of training (if applicable)

Contact Details

Data description

Use of data during the study

People

At the end of the research

Additional information

Approvals

Planned Study End Date

Approved Study Data Managers (DM)*

Other users requiring access to the SDHS study data

Designated Point of Contact

Please answer the following questions to help us confirm that the Secure Data Hosting Service provides a suitable environment for the requirements of the study;

Type of Data

Data Source

8. Extraction of data

9. Data analysis

10. Printing

11. Internet access

12. People

13. Data disposal

For further information please contact;

Contact Us

Privacy Policy

Please help us to improve

IW

Study at Cambridge

About the University

Research at Cambridge