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Disclosure of a Conflict of Interest Form This form is to be completed by any staff member who has a conflict of interest (as defined in the Conflict of Interest Policy). The staff members conflict

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How to fill out disclosure of a conflict

01

Step 1: Begin the disclosure of conflict by clearly stating your name and position within the organization.

02

Step 2: Explain the nature of the conflict that you are disclosing.

03

Step 3: Provide details of the parties involved in the conflict, including their names, roles, and relationship with you.

04

Step 4: Include a thorough description of the conflict, specifying any financial or personal interests that may be affected.

05

Step 5: Explain any steps you have taken or plan to take to address or mitigate the conflict.

06

Step 6: Sign and date the disclosure form, indicating that the information provided is accurate and complete.

07

Step 7: Submit the disclosure form to the appropriate person or department, as per your organization's guidelines.

Who needs disclosure of a conflict?

01

Employees and members of organizations who have a conflict of interest need to complete a disclosure of conflict form.

02

This includes individuals in positions where their personal or financial interests may influence their decision-making or actions within the organization.

03

It is important for transparency and ethical practices that anyone with a conflict of interest acknowledges and discloses it.

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