Preparing and Submitting a Governance Application (SSA)

Preparing the Site Specific Assessment (SSA) or Access Request application:

Please contact the LHD Research Governance Officer/s well in advance to the submission of your application. The submission of an incomplete application will delay the authorisation process.

Following discussion with the Research Governance Officer – you will be required to submit one of the following application forms:

  1. Full SSA (if your Ethics application was approved on a full NEAF)
  2. LNR SSA (if your Ethics application was approved on a LNR application)
  3. Access Request Form (to be used when there is minimum involvement by/from the LHD)

All the above forms are accessible from the Online Forms Website at

The Online Forms Website provides guidance on how to complete the application forms.  There is no requirement to upload supporting documents onto the Online Forms Website.

When preparing your SSA on the online forms website – please ensure:

  • All information relates to the relevant site (Facility and/or Local Health District).
  • Applications need to be clear in regards to the resources relating to participation by the LHD in the project eg:
    • Number in each of the participant groups (as discussed with the relevant LHD Manager)
    • Task/s  ie: what is the expected participation eg: complete online survey, participate in focus group etc
    • Timeframe – how long is each task expected to take to complete (travel time to and from a venue should be included in the timeframes)
  • When completed the SSA form must be generated and saved in PDF format from the Online Forms site

Submitting the application:

A completed SSA application to the Research Governance Officer must include:

  • A final SSA form (in PDF format) generated from the Online Forms Website (evidenced by the submission code on the bottom right hand corner of every page)
  • Completed Signatory pages ie: All investigators, supervisors (where relevant) and LHD managers as previously advised by the LHD Research Governance Officer (Investigators must not sign off as a head of department)
  • All HREC correspondence
  • HREC approved NEAF or LNR Application
  • All final HREC approved documents for use in the project – with correlating footer reference in same
  • All site specific adapted documents (where relevant) based on the HREC approved master document
  • Trials accompanied by contracts and indemnity will be required for submission in original format ie: 3 x copies of the CTRA and Indemnity documents (with evidence of a valid insurance certificate)
  • Curriculum Vitae (relevant to research experience and a limit of two (2) pages only) of all LHD/site investigators
  • Access Request applications will also require a letter or email of support from the relevant LHD Manager.

Research Governance (SSA and Access Request) applications will be accepted in electronic format - including scanned copies of the signature pages.
Click here to access the NNSW and MNC LHD – Research Governance Flow Charts
Please forward your application to the relevant Research Governance Officer:
Northern NSW Local Health District:

Rebecca Lavery

A/Research Governance Officer C/- Murwillumbah District Hospital PO Box 821 Murwillumbah NSW 2484 (02) 6672 0269 

Mid North Coast Local Health District:

Ms Maureen Lawrence

Research Governance Officer

C/- Administration Kempsey District Hospital River Street Kempsey NSW 2440 04 2888 2170 (Mondays and Tuesdays)

Further information is available from the NSW MoH Site re: Research Ethics and Governance.