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Geothermal Public Health Assessment Study Group Conflict of Interest and Bias Disclosure Statement This disclosure has been adapted and simplified from forms used by the National Academies of Science.1

How to fill out conflict of interest form

How to fill out a conflict of interest form:

1. Obtain the conflict of interest form from the appropriate source, such as your employer or an organization you are associated with.
2. Read through the form carefully to understand the purpose and requirements of disclosing conflicts of interest.
3. Begin by filling out your personal information, such as your name, contact details, and any relevant identification numbers requested.
4. Identify the nature of the conflict of interest you are disclosing. Provide a detailed description of the potential conflict and the parties involved.
5. Specify the time period during which the conflict of interest is or could be relevant. Include any relevant dates or durations.
6. Determine if the conflict of interest is related to any specific projects, contracts, or transactions. If so, provide the necessary details to enable proper consideration of the conflict.
7. Assess whether the conflict of interest could potentially impact your ability to act impartially or influence your decision-making process. Explain the potential consequences or risks associated with the conflict.
8. If applicable, propose any mitigation measures or steps you are taking to minimize or address the conflict of interest adequately.
9. Review the completed form to ensure all the necessary information has been provided accurately and comprehensively.
10. Sign and date the form to indicate your acknowledgment and consent regarding the disclosure of the conflict of interest.

Who needs a conflict of interest form:

1. Employees working in organizations where conflicts of interest may arise, irrespective of their role or position.
2. Board members or directors of companies or non-profit organizations who have decision-making authority and could potentially be influenced by conflicts of interest.
3. Government officials or public servants responsible for making impartial and unbiased decisions that may impact the public.
4. Individuals serving on committees, advisory boards, or panels that analyze proposals or make recommendations based on their expertise or knowledge in a specific field.
5. Professionals in fields such as finance, law, and healthcare, where conflicts of interest can significantly impact their ability to provide objective and unbiased advice or services.
6. Students or researchers conducting studies or experiments who need to disclose any potential conflicts that may influence their findings or objectivity.

Overall, anyone who may find themselves in a situation where their personal interests conflict with their professional responsibilities should complete a conflict of interest form. The form serves as a tool for transparency and ensures that appropriate steps can be taken to manage or mitigate any potential conflicts.

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What is conflict of interest form?

Conflict of interest form is a document used to disclose any potential conflicts of interest that an individual may have in their role.

Who is required to file conflict of interest form?

Individuals who are in positions where conflicts of interest may arise are typically required to file conflict of interest forms. This can include employees, board members, and other individuals in decision-making roles.

How to fill out conflict of interest form?

Conflict of interest forms typically require individuals to provide information about any potential conflicts of interest they may have, including relationships with outside organizations or financial interests that could impact their decision-making.

What is the purpose of conflict of interest form?

The purpose of conflict of interest form is to promote transparency and accountability by ensuring that individuals in positions of authority disclose any potential conflicts of interest that may influence their decisions.

What information must be reported on conflict of interest form?

The information that must be reported on a conflict of interest form may vary depending on the organization, but typically includes details about financial interests, relationships with outside organizations, and any other factors that could create conflicts of interest.