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APPENDIX D-1

LETTER OF CONSENT
Disyembre 2012
Maam/Sir:
Maayong adlaw!
Kami, mga estudyante sa Level I Group 14 sa Cebu Doctors University College of Medicine, maghimo ug usa ka research mahitungod sa mga water
refilling stations nga gititulohan ug Level of Compliance to Sanitary Guidelines
Issued by the Department of Health Among Selected Water Refilling Stations in
Mandaue City. Ang maong pagtuon nagtumong sa pagpakatag ug kaamguhan
sa mga water refilling stations kabahin sa sakto nga pagmentinar sa sanidad.
Ug kalinya niini, amo kamong gihangyo sa pagkumpleto sa mga pangutana nga
makatabang kanamo sa pagdeterminar sa inyong padayon nga pagsunod sa
mga tamdanan sa sanitasyon nga nagtumong sa pagsirbisyo sa mga
konsumidor.
The questionnaire is very brief and will take about ten (10) minutes or less to fill
out. Instructions for completing the questionnaire can be found on the form itself.
Please be assured that all information you provide will be kept strictly
confidential. We are not requiring you to fill up your name and contact details.
Also, your name or other identifying information will not appear on any study
report all results from the study will be reported as statistical summaries only.
Ang imong partisipasyon maghatag ug dakong kontribusyon sa katilingbanung
kahimsug. Kami mapasalamaton ug dako sa inyong kuoperasyon.
Kanimo matinahuron,

Erikka Marie R. Gambe


Group 14 Research Leader

Noted by:

Dr. Ma. Cleofe Cabang


Research Mentor

APPENDIX D-2
CONSENT FORM
Upon signing this document, I hereby give my consent to participate in the
research study entitled, Level of Compliance to Sanitary Guidelines Issued by
Department of Health among Selected Water Refilling Stations in Mandaue City.
Having been informed the detailed collection procedures, I understand the
following agreements:
1.

2.

3.

4.

The Level I College of Medicine from Cebu Doctors University will conduct the
said study for the purpose of determining the compliance of refilling station to
sanitary guidelines with regards to water handling.
I shall be assured with the rights of privacy, anonymity and confidentiality all
throughout the duration of the study. No information would be revealed to
unauthorized individuals.
This consent is granted voluntarily with my full knowledge.
I understand that all my questions about the study will be answered, and that a
copy of the results of the research shall be given to me if I asked from Erikka the
leader of the group, with a contact number of 09238594833.
IN WITNESS WHEREOF, both parties (the respondent and researchers)
have been here unto affixed their signatures on the ____ day of _____ 2012 in
Mandaue City, Philippines.
___________________________
(Signature of Respondent above
Printed Name)
Age:_______________
_____
Address _________________
________________________
Contact No._______________

_____________________________________

Signature of Researcher above Printed Name