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Funding occupational health research, training and education

and innovative workplace solutions

CLOSING DATE

May 11, 2016

SCIENTIFIC RESEARCH APPLICATION

RESEARCH AND WORKPLACE INNOVATION PROGRAM

2016

Administrative Requirements

Please 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 Re-submission

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 emailOther WCB communicationsWord of mouthRWIP brochureUniversity communications or newslettersOther, please specify

It is very important to take note of the following:

This application must be submitted electronically via email to:

Bruce M. Cielen, Manager, Research and Workplace Innovation Program at Email: [email protected] by May 11, 2016 4:00p.m. CST.

Applications must be in Word format.

There are six (6) parts to this application. Please ensure that you have provided all the information required in each part before you submit your application. A checklist to assist you is below:

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

SCIENTIFIC RESEARCH APPLICATION - RWIP 2016 1

PART 1: GENERAL INFORMATION

1.1 PROJECT TITLE

1.2 PRIORITY AREA: Please mark the appropriate box with an X

Managing Psychological InjuriesThe Use of Social Marketing in Affecting Attitudes and Behaviour Regarding Workplace Safety and Health Other topics within the mandate of the RWIP

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

NameTitleHost InstitutionBusiness Mailing AddressTelephone NumberEmailOther Contact InformationSignatureDate

If there is more than one co-applicant provide information as above.


PROJECT TITLE:

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 informationSignatureDate

1.7 SUMMARY OF SCIENTIFIC RESEARCH PROPOSAL

Please provide a summary of the research proposal that includes the following:

i. A brief description of the study to include the research question, issue or problem, how the study will address it and how the study will be done

ii. The relevance to the WCB and fit with the mandate of the Research and Workplace Innovation Program

iii. Steps to transfer research findings to end usersiv. Funding amount requestedv. Duration of study


PROJECT TITLE:

Should not exceed two (2) pages


PROJECT TITLE:

1.8 IF THIS IS A RE-SUBMISSION OF A PROPOSAL

If this proposed study is a re-submission of an earlier one please provide a response to the comments and critiques of the WCB. In the case of scientific research applications, the WCB's comments would have included the evaluation from peer reviewers. The applicant should indicate how the re-submitted application is revised based on the feedback provided by the WCB in its letter informing the applicant about the status of his or her previous application.

Should not exceed one page

PART 2: RESEARCH PROPOSAL

2.1 LITERATURE REVIEW OF EXISTING KNOWLEDGE

The review of existing knowledge in the proposed study area/s should at a minimum include the following:

i. A description of leading research and data in the body of knowledge encompassing the proposed area/s of study;

ii. An analysis of the relative strengths, weaknesses, limitations and gaps in knowledge relative to the proposed study area/s; and

iii. A discussion of key completed studies and on-going research in the Canadian context such as research by workers compensation boards, academic institutions, research organizations and other researchers which relate to this study.

2.2 RELEVANCE AND SIGNIFICANCE OF RESEARCH

i. Explain why the proposed research would be different from the information in 2.1 above;

ii. Identify the central issues and/or problems the proposed research would be addressing and explain why this is important to Manitoba; and

iii. Describe the theoretical and practical significance of the proposed research including a description of how the proposed study would fill gaps in knowledge, policy, programs or practices for workers compensation.

2.3 RESEARCH OBJECTIVES

i. Specify clearly the objectives of the research; andii. Provide the rational for the research objectives.


PROJECT TITLE:


PROJECT TITLE:

2.4 RESEARCH DESIGN AND METHODOLOGY

Please provide a clear explanation of the theoretical/conceptual framework guiding the research. Your explanation should at a minimum include:

i. Key concepts and definitions;ii. Rationale for selection of theoretical framework;

iii. Research methodology; andiv. Sample Information: description, estimated size, etc. and sources

that will provide the basis for selection of sample.

If you plan to use proven research instruments please attach copies.

2.5 DATA ANALYSIS

i. Indicate if your study will require data from the WCB or Workplace Safety and Health Division, Manitoba Labour and Immigration.

ii. Identify data sources; iii. Describe the method/s and software requirements;iv. Describe the types of data that will address research objectives and

issues; andv. Indicate if methodology needs approval of an ethics review board and

whether the study involves any of the following:

a) Human subjects;b) Stem cells;c) Vertebrate animals;d) Biological research hazards; ande) An environmental impact or assessment.

2.6 SCOPE OF RESEARCH

i. State what the study will address and areas that will not be covered by study;

ii. Explain the linkage between the scope of the study relative to the budget request; and

iii. Describe how the study's scope anticipates successful completion within the proposed project's duration.

2.7 KNOWLEDGE TRANSFER and EXCHANGE (KTE)

An on-going objective of the RWIP is to ensure the resources developed and learning gained from RWIP projects are broadly shared and used by WCB


PROJECT TITLE:

leadership and staff, other researchers, Manitoba employers, workers and policy makers. The KTE plan should apply the integrated KTE process to engage stakeholders, decision-makers and knowledge users during the life of a project. The KTE plan should also include activities to promote successful project outcomes, best practices and research evidence into practical applications that can be used to prevent occupational injury, illness and disease and to foster successful rehabilitation and productive return-to-work of injured or ill workers.

More information on KTE for RWIP projects is provided in sections 5.2 and 5.3 of the Applicant Information document.

The estimated cost for KTE should be included in the project's budget. See Section 7.6 of the Applicant Information for more information on the budget requirements.

PART 3: MANAGEMENT OF PROJECT

Please provide a timetable and work plan that will:

i. Identify and describe project activities; ii. Specify key milestones;

iii. Identify start and finish dates; and iv. Relate costs to project activities.

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


PART 4: RISK ASSESSMENT

Identify the potential risks to successful completion of the project, e.g. cooperation from workplace parties, participation of subjects, resource availability etc.

Use the Risk Assessment Matrix below to describe the risks and potential solutions to mitigate the risks identified.


PROJECT TITLE:


PROJECT TITLE:

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


PART 5: PROJECT BUDGET

5.1 EXPLANATION OF BUDGET AND JUSTIFICATION OF BUDGET ITEMS

Use the format below to assist you in completing the budget.

The WCB will provide support for the direct costs of the project [including project assistance, support for technical, professional and secretarial services, equipment (purchase or rental), project-related travel and supplies].

Project costs may include reasonable administrative costs, but should not include blanket surcharges for institutional overhead, costs of salary replacement for staff involved in project, buy-outs of teaching time or other responsibilities of the applicant/s, co-applicant/s or the study's partners.

Applicants must also demonstrate that the WCB grant and/or any financing from other sources will provide adequate financial support to achieve the objectives of the proposal.

Please take note that the WCB is GST exempt.


PROJECT TITLE:

BUDGET ITEMS AND JUSTIFICATION1

Year 1 Year 2 Total

Budget Item WCB $ Request

WCB $ Request

WCB $ Request Justification of Funds

1 Salaries, Benefits/Consultancy fees2 (Specify for each of project team)

Sub-Total2 Material and supplies

(list each item greater than $1,000)

Subtotal3 Equipment

(purchase, rental, lease)

Subtotal4 KTE

Subtotal5 Travel,

accommodation and meals3

Subtotal6 Other costs (specify

by item; for example stipends paid to individuals in sample

SubtotalTotal WCB Funding

Request (sum of items 1 to 6)

Specific project costs met by the employer ( in-kind)

Subtotal1Include all items essential for the conduct of the project. Provide a brief, clear justification for each budget item and relate it to the objectives and requirements of the proposed research. The budget quantifies the timetable and work plan in terms of personnel, materials, supplies, and other


PROJECT TITLE:

requirements. Accordingly, it is essential that the link between the research proposal and the budget be clear.2 Applies for new staff or consultants hired to work on the project. It should not include salaries or benefits of current employees participating or involved in the project.3 Any cost of transportation, accommodation and meals paid according to WCB Manitoba rates. Estimate the number of days, transportation, accommodation and meal costs by number of persons and number of days. See Section 12 of the Applicant Information document for WCB Manitoba rates for travel, accommodation and meals.

PART 6: RESEARCH TEAM INFORMATION

6.1. BIOGRAPHICAL SKETCH OF PRINCIPAL APPLICANT, CO-APPLICANT/S AND OTHER TEAM MEMBERS

Each biographical sketch:

i. must be part of the electronic application form;ii. may not be longer than 5 pages; and

iii. include the following elements:o full name and title;o institution or organization;o educational background (institution, degree/diploma,

certificate/qualification conferred, year conferred, and field of study);

o research and professional experience; o publications, ando funding applied for and received.

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


PROJECT TITLE:

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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