Conflict of Interest Disclosure Form
|
|
- Lilian Tyler
- 6 years ago
- Views:
Transcription
1 Fill out this paper form only if you are not required to complete the University s on-line outside interest disclosure form (M-Inform) and have a real, perceived or potential conflict of interest. Please check with your supervisor or contact dds-compliance@umich.edu if you do not know if you are required to complete this form. Please return completed forms to your supervisor or committee chair, as appropriate, or contact ddscompliance@umich.edu for routing assistance. See definitional section for italicized words. General Information Name (Last, First, Middle): Date: Job Title: UM Employee Yes No Department/Unit: Phone # Supervisor's Name: Part I: Preliminary Questions Yes No a. I participate or expect to participate as an investigator in Public Health Service funded research within 90 days (NIH, AHRQ, SAMHSA, HRSA, FDA, CDC, ATSDR, HIS, etc.). Stop: If you answered yes to Part I(a), you must complete the on-line disclosure form. To do this, go to If you cannot logon, please contact dds-compliance@umich.edu for assistance. If you answered no, please continue filling out this form. b. I or my spouse, domestic partner, or dependents: Yes No Attend a UM School of Dentistry Committee that requires an outside interest, activity or relationship disclosure (go to for assistance) Engage in paid or unpaid outside activities, interests, or relationships that are related to my UM institutional responsibilities Hold ownership in a company or business (including equity, stock, or stock options) that is related to my UM institutional responsibilities. Hold ownership in a company or business (including equity, stock, or stock options) that seeks to do business with the University or its employees. Receive or expect to receive compensation, loans (other than student loans), other payment(s) or items of value related to my UM institutional responsibilities. Make purchasing decisions for or at the University related to my institutional responsibilities. Participate as an investigator on non-phs funded research sponsored by an outside organization related to my UM responsibilities and with which I, my spouse, domestic partner, or dependents have a paid or unpaid interest, activity, or relationship. Stop: If you answered no to all questions in Part I(a) and (b), please review your answers with your supervisor or committee leadership, as appropriate, and go to Part III, Section A to sign and date this form. A copy of this form should be kept on file by you, your supervisor or committee leadership. Please forward an electronic copy to your human resources representative and to dds-compliance@umich.edu. If you answered yes to any of the questions in Part I (b), please continue filling out this form. Version
2 Part II. Complete this form separately for each outside organization related to your institutional responsibilities and with which you, your spouse, domestic partner, or dependents have an interest, activity, or relationship. Part II: Outside Interest, Activity, or Relationship Detail Information Section A: Outside Organization Information Activity, Interest, or Relationship is for (select all that apply): Me Spouse, Domestic Partner, or Dependent Name of Outside Organization involved in this interest, activity, or relationship Duration of Interest, Activity or Relationship: Ongoing Publicly Traded Non-Publicly Traded Other (non-profit, etc.) Date Specific - add actual or estimated dates: Or Start Date: End Date: Section B: Interest, Activity, or Relationship with Outside Organization 1. Select the following descriptors that apply to the outside organization identified in Part II, Section A: Consultant/Advisor Expert Witness Speakers Bureau Conduct Training Employee Advisory, Strategic, or Medical Board Lecturer Honoraria Other (Please describe): Leadership role Officer (trustee, manager, president) Leadership role Director (member; not an officer) 2. Select all that apply to your financial arrangement with this outside organization: Equity Interest (stock, stock option, other ownership or partnership interest). Percent (%) Ownership: < 1% 1% - 5% >5% Receive payments related to intellectual property (e.g., royalties, milestone, option fees, etc.) Distributed by UM Distributed by the outside organization involved in this interest, activity, or relationship Both Other (e.g., agreements or other contractual relationships). Please describe: 3. Remuneration expected from the outside organization identified in Part II, Section A, for fiscal year July 1 to June 30. Fiscal Year (July 1 to June 30) Version
3 Part III: Signatures and Conflict Management Strategies (where applicable) to reduce or eliminate any identified conflicts of interest. Part III. Attestation and Conflict Management Strategies (if applicable) Section A: Attestation (Signature and Date Required Fields) I certify that the information provided is accurate to the best of my knowledge. I agree that I will update this disclosure promptly when my circumstances change. I understand that failure to fully and honestly disclose my outside interests, activities, or relationships can result in disciplinary action up to and including termination. I certify that I have read and agree to abide with UM School of Dentistry Policy (Faculty) or Policy (staff) related to Outside Interests and Conflicts of Interest and SPG , Conflicts of Interest and Conflicts of Commitment. Print Name (Disclosing Party) Signature Date I certify that I reviewed the completed outside interest disclosure form and agree that a conflict management plan is not applicable for the disclosing party. Print Name (Manager or Committee Chair) Signature Date Section B: Conflict Management Strategies to Reduce or Eliminate Identified COI Describe Conflict(s) of Interest: Outline COI Management Strategies (working with your supervisor, describe the steps that you will take to reduce or eliminate the identified conflict of interest (use an additional sheet of paper if necessary.) I will abide by the conflict management strategies outlined above. I agree to promptly update these management strategies when my circumstances change. I understand that failure to comply with the outlined management strategies can result in disciplinary action up to and including termination. Print Name (Disclosing Party) Signature Date I certify that I reviewed the completed outside interest disclosure form and agree that a conflict management plan is not applicable for the disclosing party. Print Name (Manager or Committee Chair) Signature Date Version
4 DEFINITIONS Conflict of Interest Disclosure Form Public Health Service Agencies within the Public Health Service include: Agency for Toxic Substances and Disease Registry (ATSDR); Centers for Disease Control and Prevention (CDC); Food and Drug Administration (FDA); Health Resources and Services Administration (HRSA); Indian Health Services (IHS); National Institutes of Health (NIH); Substance Abuse and Mental Health Services Administration (SAMHSA). Outside Organization is any commercial, for profit (publicly traded or not) company, and any non-profit, or non-governmental, entity other than the University of Michigan. Outside interest, activity, or relationship is a non-university interest, activity, or relationship, whether paid or unpaid. Related is when an outside interest, activity, or relationship relies upon the same expertise that an individual s ability to carry out his or her institutional responsibilities relies upon. Also, any interest, activity, or relationship that has the potential to influence the duties that the University considers part of the work it pays or otherwise engages an individual to do. Institutional Responsibilities refers to an individual s professional responsibilities on behalf of the University, such as research, teaching, conduct of sponsored projects, professional practice, and service on institutional committees. Remuneration means payments of any kind from an outside organization, except: payments from a federal, state, or local government agency, a domestic nonprofit institution of higher education; income from investment vehicles such as mutual funds and retirement accounts; book royalties and royalties paid through UM. Conflict of Interest or COI exists whenever personal, professional, commercial, or financial interests or activities outside of the University or UM School of Dentistry have the possibility (either in actuality or in appearance) of: Compromising a UM School of Dentistry faculty or staff s judgment, Biasing the nature or direction of scholarly research, Influencing a UM School of Dentistry faculty, house officer or staff s decision or behavior with respect to teaching and student affairs, appointments and promotions, uses of University or UM School of Dentistry resources, interactions with patients or human subjects, or other matters of interest to the University or UM School of Dentistry, or Resulting in a personal gain for a UM School of Dentistry faculty, or staff or for their Family Members' gain or advancement at the expense of the University or UM School of Dentistry. DISCLOSURE PRIVACY STATEMENT The information you provide in this document is collected in accordance with the requirements of the UM School of Dentistry Policy (Faculty) or Policy (staff) related to Outside Interests and Conflicts of Interest. These policies require the disclosure of all potential material conflicts of interest by an individual to their supervisor. Failure to disclose potential conflicts could lead to disciplinary action up to and including termination. Sensitive and Confidential Information UM School of Dentistry recognizes that the information provided by you in this disclosure is personal and sensitive. UM School of Dentistry considers the information to have been given in confidence, and undertakes to treat it confidentially to the extent permitted by law. The information you provide related to your conflict may be disclosed to others that need this information to perform their UM School of Dentistry obligations or to make decisions on behalf of UM School of Dentistry (e.g., Human Resources, Compliance Officer, Conflict of Interest boards or committees, Health System Legal Office, etc). The information you provide is available through the Michigan Freedom of Information Act, Public Act No. 442 of Access and Retention Version
5 This document and any copies will be retained in your personnel file. It will be accessible only to those that demonstrate a need to view this information. Version
APPENDIX 2: COMPLIANCE WITH REVISED PUBLIC HEALTH SERVICE REGULATIONS
APPENDIX 2: COMPLIANCE WITH REVISED PUBLIC HEALTH SERVICE REGULATIONS This Appendix to the Columbia University Policy on Financial Conflicts of Interest and Research (the Policy ) documents the policies
More informationPOLICY ON CONFLICT OF INTEREST AND CONFLICT OF COMMITMENT 47
POLICY ON CONFLICT OF INTEREST AND CONFLICT OF COMMITMENT 47 I Preamble 1. Ball State University is committed to providing quality teaching, research, and service. Often, this mission is served by the
More informationUniversity of Nebraska at Omaha Academic and Research Financial Conflict of Interest Policy
University of Nebraska at Omaha Academic and Research Financial Conflict of Interest Policy This document describes the University of Nebraska at Omaha s (UNO) Financial Conflict of Interest (COI) policies
More informationUNIVERSITY OF CENTRAL FLORIDA POTENTIAL OUTSIDE ACTIVITY, EMPLOYMENT, AND CONFLICT OF INTEREST AND COMMITMENT DISCLOSURE (AA-21)
Home Sign Off COI Proxy for: Christina L Serra Exit COI Proxy Mode Potential Outside Activity, Employment, and Conflict of Interest and Commitment Disclosure (AA-21) Need help? Review the training materials
More informationCode of Conduct and Conflicts of Interest Policy [Revised 3/23/07, 7/31/07 and 12/18/07]
UNIVERSITY OF MICHIGAN ATHLETICS DEPARTMENT Code of Conduct and Conflicts of Interest Policy [Revised 3/23/07, 7/31/07 and 12/18/07] Introduction The Athletics Department coaches, staff, and members of
More informationUNIVERSITY OF TENNESSEE GRADUATE SCHOOL OF MEDICINE INSTITUTIONAL REVIEW BOARD CONFLICTS OF INTEREST
UNIVERSITY OF TENNESSEE GRADUATE SCHOOL OF MEDICINE INSTITUTIONAL REVIEW BOARD CONFLICTS OF INTEREST I. PURPOSE To document the policy and procedures used by the University of Tennessee Graduate School
More informationDISCLOSURE OF OUTSIDE ACTIVITIES AND FINANCIAL INTERESTS FORM
General Remarks DISCLOSURE OF OUTSIDE ACTIVITIES AND FINANCIAL INTERESTS FORM University of Florida Instructions for Completing the Disclosure of Outside Activities and Financial Interests Form University
More informationInvestigator Conflict of Interest Disclosure Policy for Human Subjects Research
55 Fogg Road South Weymouth Massachusetts 02190-2455 Investigator Conflict of Interest Disclosure Policy for Human Subjects Research PURPOSE OF POLICY Financial or other incentives may negatively impact
More informationUNIVERSITY OF TENNESSEE GRADUATE SCHOOL OF MEDICINE INSTITUTIONAL REVIEW BOARD CONFLICTS OF INTEREST
UNIVERSITY OF TENNESSEE GRADUATE SCHOOL OF MEDICINE INSTITUTIONAL REVIEW BOARD CONFLICTS OF INTEREST I. PURPOSE To document the policy and procedures used by the University of Tennessee Graduate School
More informationLOUISIANA COMMUNITY & TECHNICAL COLLEGE SYSTEM Policy No
LOUISIANA COMMUNITY & TECHNICAL COLLEGE SYSTEM Policy No. 6.018 Title: Outside Employment of LCTCS Employees Authority: LCTCS Board Action 06/13/07 Board of Regents Action 08/23/07 Ethics Board Action
More informationLOUISIANA COMMUNITY & TECHNICAL COLLEGE SYSTEM Policy No
LOUISIANA COMMUNITY & TECHNICAL COLLEGE SYSTEM Policy No. 6.018 Title: Outside Employment of LCTCS Employees Authority: LCTCS Board Action Original Adoption: 12/12/01 Board of Regents Action Effective
More informationLouisiana State University System
May 12, 1993 SUBJECT: Outside Employment of University Employees -- PM-11 This memorandum rescinds PM-II dated October 4, 1991 and PM-66 dated March 22, 1988. I. INTRODUCTION Louisiana State University
More informationConflict of Interest Policy. Version Approved by Approval date Effective date Next full review. All persons subject to the UNSW Code of Conduct
Conflict of Interest Policy Version Approved by Approval date Effective date Next full review 1.3 Administrative update by the Director of Governance Policy Statement 8 August 2017 15 August 2017 April
More informationUUCME Speaker / Planner Disclosure Form
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), The University of Utah School of Medicine Continuing Medical Education Office (UUCME) requires disclosure of
More informationFinancial Conflict of Interest/Conflict of Commitment
800.12 Financial Conflict of Interest/Conflict of Commitment Purpose To promote objectivity in research by establishing standards that provide a reasonable expectation that the design, conduct, and reporting
More informationRULES OF UNIVERSITY OF FLORIDA. 6C University of Florida; Disclosure and Regulation of Outside Activities and
RULES OF UNIVERSITY OF FLORIDA 6C1-1.011 University of Florida; Disclosure and Regulation of Outside Activities and Financial Interests. (1) General Requirements. (a) The faculty and staff members of the
More informationUniversity of Louisiana System
Policy Number: FS-III.VII.-1 University of Louisiana System Title: OUTSIDE EMPLOYMENT/ PROCEDURES Effective Date: February, 1995 Cancellation: None Chapter: Faculty and Staff I. INTRODUCTION Policy and
More informationUNIVERSITY OF FLORIDA COLLEGE OF MEDICINE-JACKSONVILLE. Subject: Outside Activities by Residents/Fellows
Approval Date: 6/7/2016 UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE-JACKSONVILLE Subject: Outside Activities by Residents/Fellows Page 1 of 3 Approved by: GMEC Revised Date: 5/10/2016 Effective Date: 9/4/2012
More informationCONFLICT OF INTEREST POLICY
CONFLICT OF INTEREST POLICY Responsible Officer Contact Officer Head of School Superseded Documents Review 18 April 2008 File Number 2005/0311 Code of Conduct UNSW Statement of Business Ethics Responsible
More informationPolicy on Commercial Support and Financial Disclosure
Policy on Commercial Support and Financial Disclosure Commercial Support of Continuing Education Activities The Aerospace Medical Association CME program uses an Annual Scientific Meeting and workshops
More informationSOUTH DAKOTA BOARD OF REGENTS. Policy Manual
SUBJECT: Conflict of Interest NUMBER: 4:35 SOUTH DAKOTA BOARD OF REGENTS Policy Manual 1. Persons employed full-time by the South Dakota Board of Regents in professional capacities, whether as faculty
More informationYORK COUNTY COMMUNITY FOUNDATION. Code of Conduct and Conflict of Interest Policy
YORK COUNTY COMMUNITY FOUNDATION Code of Conduct and Conflict of Interest Policy Statement of Policy Purpose The York County Community Foundation (the Foundation ) believes that effective nonprofit governance
More informationOutside Employment. such non-cash economic benefit shall not have a present value significantly in excess of POLICY NUMBER: -'S=L=C=C--'-'H=R-=-5=-0=8
POLICY NUMBER: -'S=L=C=C--'-'H=R-=-5=-0=8 POLICY AND PROCEDURES MEMORANDUM Title: Outside Employment Effective Date: Fall 2011 Date of Last Revision: Cancellation: Office: Outside Employment SLCC recognizes
More informationUTAH VALLEY UNIVERSITY Policies and Procedures
Page 1 of 8 POLICY TITLE Section Subsection Responsible Office Conflict of Interest Governance, Organization, and General Information Governance and Organization Office of the Vice President of Finance
More informationCONFLICT OF INTEREST OR COMMITMENT
03.230 CONFLICT OF INTEREST OR COMMITMENT Authority: Chancellor History: Revised 08/23/12; Revised and Reformatted 10/20/06; Adopted 01/01/96; supersedes former Policy No. MSC 1.50 Source of UNC Policy
More informationConflict of Interest or Commitment
Conflict of Interest or Commitment The Mission of Palmer College of Chiropractic (College) is communicated through core institutional documents describing our Identity, Vision, Values, Practice Paradigm,
More informationIACUC MEMBER CONFLICT OF INTEREST
IACUC MEMBER CONFLICT OF INTEREST 1. Overview Federal regulations do not permit an Institutional Animal Care and Use Committee (IACUC) member to participate in the review of research in which he/she has
More informationCODE OF ETHICS FOR SENIOR FINANCIAL AND EXECUTIVE OFFICERS
CODE OF ETHICS FOR SENIOR FINANCIAL AND EXECUTIVE OFFICERS GameStop Corp. (the Company ) is committed to full and accurate financial disclosure in compliance with applicable laws, rules and regulations
More informationConflict of Interest Policy
Conflict of Interest Policy Purpose RCSI is committed to maintaining the highest standards of conduct in all aspects of our activity. This policy aims to effectively manage potential conflicts of interest,
More informationConflicts of Interest, Conflicts of Commitment, and Outside Activities
Conflicts of Interest, Conflicts of Commitment, and Outside Activities Section: Chapter: Date Updated: V: Human Resources 29 July 28, 2016 29.1 Policy 29.1.1 Applicability. This policy applies to all University
More informationCode of ethics Code of BUsiNess CoNdUCt ANd ethics for employees ANd directors i. PURPose of Code ii. introduction iii. CoNfLiCts of interest
CODE OF BUSINESS CONDUCT AND ETHICS FOR EMPLOYEES AND DIRECTORS I. Purpose of Code The purpose of this Code is: to promote the honest and ethical conduct of our directors and employees, including the ethical
More informationProcedures for the Implementation of the ICIC Policy. Individual Conflict of Interest and Commitment Policy ROCHESTER INSTITUTE OF TECHNOLOGY
Procedures for the Implementation of the Individual Conflict of Interest and Commitment Policy ROCHESTER INSTITUTE OF TECHNOLOGY This document implements the Individual Conflict of Interest and Commitment
More informationConflict of Interest
Conflict of Interest The University s Individual Integrity Policy (Conflict of Interest) requires that its employees disclose any potential conflict of interest which could influence any decision or action
More informationDisclosing Potential Conflicts of Interest
Introduction Disclosing Potential Conflicts of Interest In compliance with the Centers for Medicare and Medicaid Services' (CMS) requirements for qualified provider led entities (qple), the ACR has a policy
More informationConflicts of Interest, Conflicts of Commitment, and Outside Activities
Conflicts of Interest, Conflicts of Commitment, and Outside Activities Section: Chapter: Date Updated: V: Human Resources 29 December 17, 2013 29.1. Policy 29.1.1 Applicability. This policy applies to
More informationConflict of Interest, Conflict of Commitment, and Outside Activities
Conflict of Interest, Conflict of Commitment, and Outside Activities UTSA HOP 1.33 Full time Non Tenure Track Faculty not engaged in Research and full time Covered UTSA staff 1 The following slides are
More informationPolicy on Conflict of Interest and Commitment
HUMAN RESOURCES Effective Date: January 2002 Date Revised: April 18, 2014 Supersedes: Related Policies: Code of Ethical Conduct; Professional Standards and Business Conduct Policy; Faculty Conflict of
More information1201 Maryland Avenue SW, Suite 900, Washington, DC ,
1201 Maryland Avenue SW, Suite 900, Washington, DC 20024 202-962-9200, www.bio.org July 7, 2009 Jerry Moore NIH Regulations Officer NIH, Office of Management Assessment 6011 Executive Boulevard, Suite
More informationConflict of Interest Policy
Conflict of Interest Policy Purpose RCSI is committed to maintaining the highest standards of conduct in all aspects of our activity. This policy aims to effectively manage potential conflicts of interest,
More informationGOODWILL INDUSTRIES OF COLORADO SPRINGS. Memorandum October 11, 2005 HUMAN RESOURCES Ethics Code
GOODWILL INDUSTRIES OF COLORADO SPRINGS Memorandum 45-41 October 11, 2005 HUMAN RESOURCES Ethics Code 1. PURPOSE: To establish a value statement and code of ethics, which will form the basis of how we
More informationGUIDELINES FOR THE BOARD OF DIRECTORS
I. INTRODUCTION 1. The Board of Directors (Board) of Finning International Inc. (Corporation) believes that the principal objective of the Corporation is to generate long-term shareholder value. The Board
More informationGeneral Practice Services Committee (GPSC) Policy on Declaration of Competing Interests
General Practice Services Committee (GPSC) Policy on Declaration of Competing Interests A competing interest exists when professional judgment concerning a primary interest (such as patients' welfare)
More informationStaff Conflict of Interest Policy
Revision or Issue Date: February 28, 2018 Effective Date: November 1, 2016 Policy Authority: James McMillan Applicable Jurisdictions: Global (except France, French Polynesia, and New Caledonia) ------------------------------------------------------------------------------------------------------------
More informationStaff Conflict of Interest Policy
Revision or Issue Date: February 5, 2019 Effective Date: November 1, 2016 Policy Authority: James McMillan Applicable Jurisdictions: Global (except France, French Polynesia, and New Caledonia) ------------------------------------------------------------------------------------------------------------
More informationAmerican Boer Goat Association. Board of Director Responsibilities
American Boer Goat Association TM Board of Director Responsibilities GENERAL INFORMATION: Position: Board Member Volunteer: (non-paid position) Part Time: Minimum of fifteen hours monthly (meetings, preparation,
More informationAmerican Boer Goat Association. Board of Director Responsibilities
American Boer Goat Association TM Board of Director Responsibilities GENERAL INFORMATION: Position: Board Member Volunteer: (non-paid position) Part Time: Minimum of fifteen hours monthly (meetings, preparation,
More informationMacLean-Fogg Company Conflict of Interest Policy
MacLean-Fogg Company Conflict of Interest Policy EFFECTIVE DATE: February 15, 2018 OWNER: Corporate Compliance POLICY NUMBER: MF-LC2.01-P-20180215-CONFLICT OF INTEREST OUR STANDARD: We must avoid circumstances
More informationSample Conflict of Interest Policies from the Council
Sample Conflict of Interest Policies from the Council Sample One: For Staff and Board Code of Conduct I. Introduction The Foundation is a publicly supported charitable foundation serving the communities
More informationExamples of Potential Reporter Scenarios Related to fcoi Reporting Procedure
Examples of Potential Reporter Scenarios Related to fcoi Reporting Procedure In performing research or research related duties at Cornell, there are several types of conflicts of interest that, if not
More informationRemuneration Committee Charter. 1 Composition. 2 Role. 3 Operations. 4 Responsibilities. Syndicated Metals Limited ACN (Company)
Syndicated Metals Limited ACN 115 768 986 (Company) 1 Composition The Remuneration Committee shall be structured so that it has at least two members, both of whom are non-executive directors and it is
More informationAPOGEE ENTERPRISES, INC. CORPORATE GOVERNANCE GUIDELINES
APOGEE ENTERPRISES, INC. CORPORATE GOVERNANCE GUIDELINES The business of Apogee Enterprises, Inc. ( Apogee or the Company ) is managed under the direction of the Company s Board of Directors ( Board ).
More informationConflicts of Interest and Conflicts of Commitment Policy and Approval Guidelines
Conflicts of Interest and Conflicts of Commitment Policy and Approval Guidelines 8.2.18.2 Conflicts of Interest and Conflicts of Commitment 8.2.18.2.1 Conflicts of Interest and Appearances of Conflicts
More informationCITRIX SYSTEMS, INC. CORPORATE GOVERNANCE GUIDELINES. 1. Separation of the Positions of Chairperson and CEO
CITRIX SYSTEMS, INC. CORPORATE GOVERNANCE GUIDELINES Set forth below are Citrix Systems, Inc. s corporate governance policies. These guidelines are subject to change from time to time at the direction
More informationAll Souls College, Oxford
GPC/1097 (revised) All Souls College, Oxford Statement of Policy and Procedure on Conflict of Interest Adopted by the Warden and Fellows of All Souls College on 5 December 2009 Introduction 1. The Warden
More informationExamples of Potential Reporter Scenarios Related to fcoi Reporting Procedure
Examples of Potential Reporter Scenarios Related to fcoi Reporting Procedure In performing research or research related duties at Cornell, there are several types of conflicts of interest that, if not
More informationAmerican College of Chest Physicians Leadership Conflict-of-Interest (COI) Policy
American College of Chest Physicians Leadership Conflict-of-Interest (COI) Policy (Adopted by the Board of Regents on October 29, 2010 and Amended October 2018) 1) STRUCTURE. Level I: Level I leaders are:
More informationTreasurer - The Treasurer will serve a one-year term beginning on the first day of the calendar year immediately following his/her election.
Application Memo Thank you for considering running for a national leadership position with AADE! A clear understanding of the responsibilities, expectations, and commitment required is essential prior
More informationAK Steel Corporate Governance Guidelines
A AK Steel Corporate Governance Guidelines I. Introduction and Statement of Purpose The Board of Directors of AK Steel Holding Corporation (with AK Steel Corporation, collectively referred to herein as
More informationTHE ASME CRITERIA FOR INTERPRETATION OF THE CANONS
THE ASME CRITERIA FOR INTERPRETATION OF THE CANONS The ASME criteria for interpretation of the Canons are guidelines and represent the objectives toward which members of the engineering profession should
More informationUNIVERSITY of HOUSTON MANUAL OF ADMINISTRATIVE POLICIES AND PROCEDURES
UNIVERSITY of HOUSTON MANUAL OF ADMINISTRATIVE POLICIES AND PROCEDURES SECTION: Procurement Number 04.00.00 AREA: Reference SUBJECT: Code of Conduct - Procurement Responsibilities I. PURPOSE AND SCOPE
More informationAdopted by the Board on 11 April 2005 and revised on 23 June 2009 (ASX Governance Principles and Recommendations: Recommendation 1.
Domino's Pizza Enterprises Limited Board Charter Adopted by the Board on 11 April 2005 and revised on 23 June 2009 (ASX Governance Principles and Recommendations: Recommendation 1.1) 1 Corporate Governance
More informationCode for the Assessment and Management of Conflict of Interest
Updated January 2018 Purpose and Application: Code for the Assessment and Management of Conflict of Interest Complex relationships with for profit and not for profit organizations and entities may by their
More informationNā Wai Ola Public Charter School CONFLICT OF INTEREST & DISCLOSURE POLICY
SECTION 1. PURPOSE: Nā Wai Ola Public Charter School CONFLICT OF INTEREST & DISCLOSURE POLICY Nā Wai Ola Public Charter School is a state-funded organization that has autonomy in most matters. However,
More informationSample Position Description Board of Directors
Sample Position Description Board of Directors Duties and Expectations of a Director Purpose The hospital is committed to ensuring that it achieves standards of excellence in the quality of its governance
More informationIASLC CME Department planners/reviewers/iaslc Ethics Committee/CME Subcommittee et. al. will identify,
DISCLOSURE OF FINANCIAL RELATIONSHIPS RESOLUTION OF CONFLICT OF INTEREST PROCEDURES (COI) CONFLICT OF INTEREST POLICY FOR PROGRAM PLANNERS, SPEAKERS, MODERATORS, REVIEWERS AND AUTHORS OF CONTINUING MEDICAL
More informationIASLC CME Department planners/reviewers/iaslc Ethics Committee/CME Subcommittee et. al. will identify,
DISCLOSURE OF FINANCIAL RELATIONSHIPS RESOLUTION OF CONFLICT OF INTEREST PROCEDURES (COI) CONFLICT OF INTEREST POLICY FOR PROGRAM PLANNERS, SPEAKERS, MODERATORS, REVIEWERS AND AUTHORS OF CONTINUING MEDICAL
More informationCONFLICT OF INTEREST POLICY FOR BAPTIST HEALTH SOUTH FLORIDA, INC. AND ITS AFFILIATES
CONFLICT OF INTEREST POLICY FOR BAPTIST HEALTH SOUTH FLORIDA, INC. AND ITS AFFILIATES The purpose of this Conflict of Interest Policy is: I. PURPOSE (A) to protect the interests of ( Baptist Health ) and
More informationThe Board has also adopted the following governance objectives. 9. To ensure the effective monitoring and management of health and safety.
Board Charter June 2017 Introduction This charter and the board committees charters and policies set out the governance requirements for the Spark New Zealand Board. These include the roles and responsibilities,
More informationCode of Conduct. Integral Diagnostics Limited ACN
Code of Conduct Integral Diagnostics Limited ACN 130 832 816 Date: 1 October 2015 Code of Conduct Part A Scope and application 1 Purpose of the Code The Company is committed to a high level of integrity
More informationMiMedx Group, Inc. Code of Business Conduct and Ethics
MiMedx Group, Inc. Code of Business Conduct and Ethics 1. Introduction. 1.1 The Board of Directors of MiMedx Group, Inc. (together with its subsidiaries, the "Company") has adopted this Code of Business
More informationConflict of Interest REPLACES POLICY DATED: 08/01/04, HPG.003, Procedures for HPG Colleagues to Avoid Conflicts of Interest; 11/02/12, HT.
PAGE: 1 of 9 SCOPE: All departments within HealthTrust Purchasing Group, L.P. ( HealthTrust LP ) and its direct and indirect subsidiaries including HealthTrust-Europe LLP ( HealthTrust Europe ); the representative
More informationCORPORATE GOVERNANCE GUIDELINES
CORPORATE GOVERNANCE GUIDELINES (Effective May 18, 2018) I. INTRODUCTION The Board of Directors (the Board ) of CBRE Group, Inc. (the Company ) has adopted these corporate governance guidelines to promote
More informationCISION LTD. CORPORATE GOVERNANCE GUIDELINES OF THE BOARD OF DIRECTORS. (Adopted on June 29, 2017)
CISION LTD. CORPORATE GOVERNANCE GUIDELINES OF THE BOARD OF DIRECTORS (Adopted on June 29, 2017) A. Introduction; role of the board The board of directors has adopted these policies as a general framework
More informationConflict of Interest Policy and Procedure
Conflict of Interest Policy and Procedure July 2017 Version 4.0 Policy authorised by Responsible Officer CONFLICT OF INTEREST POLICY JULY 2017 PAGE 1 OF 7 Table of Contents 1.0 Introduction...3 2.0 Scope
More informationOutside Employment of Faculty and Non-Classified Staff Members for Compensation: Concurrent Employment
Outside Employment of Faculty and Non-Classified Staff Members for Compensation: Concurrent Employment January 19, 2016 Background information The following discussion and draft guidelines are based upon
More informationWe Maintain Accurate Financial Books and Records. We Strive to Comply with All Laws and Regulations. We Maintain the Confidences Entrusted to Us
Code of Business Conduct and Ethics Contents: 1. Introduction: Philosophy Underlying This Code 2. 10 Principles: principles that establish a framework and provide guidance to all employees on how to ensure
More informationI. DEFINITIONS WHAT IS REQUIRED TO BE DISCLOSED HOW TO DISCLOSE V. COLLECTION AND REVIEW OF DISCLOSURE FORMS OVERSIGHT MANAGEMENT PLANS (OMP)
I. DEFINITIONS II. III. IV. OVERVIEW WHAT IS REQUIRED TO BE DISCLOSED HOW TO DISCLOSE V. COLLECTION AND REVIEW OF DISCLOSURE FORMS VI. VII. VIII. IX. OVERSIGHT MANAGEMENT PLANS (OMP) CONFLICTS IN THE REVIEW/OVERSIGHT
More informationRULES OF PROCEDURE OF THE MEDICAL DEVICE COORDINATION GROUP. The Medical Device Coordination Group (hereinafter the MDCG ),
RULES OF PROCEDURE OF THE MEDICAL DEVICE COORDINATION GROUP The Medical Device Coordination Group (hereinafter the MDCG ), Having regard to Regulation (EU) 2017/745 of the European Parliament and of the
More informationCONFLICTS OF INTEREST POLICY AND PROCEDURES
THE ECU GROUP PLC CONFLICTS OF INTEREST POLICY AND PROCEDURES CONTENTS The Guiding Principles... 2 Overview... 2 Obligations in respect of management of Conflicts of Interest... 3 Senior Management Responsibilities...
More informationDISCLOSURE STATEMENT
DISCLOSURE STATEMENT In compliance with American Speech-Language Hearing Association s Continuing Education Board s Requirements, Texas Tech University Health Sciences Center requires course planners and
More informationMooresville Volunteer Program Guide
Mooresville Volunteer Program Guide Town of Mooresville This guide will assist volunteers in not only being successful with their volunteer opportunity, but also becoming an active part of our community
More informationRoswell Park Cancer Institute. Number: Date Issued: 3/1/ Policy and Procedure Title: Outside Activity and Honoraria.
Roswell Park Cancer Institute Policy and Procedure Title: Outside Activity and Honoraria Date Issued: 3/1/2000 Revision: 8 Number: 218.1 Effective Date: 6/6/16 Prepared by: Outside Activity Committee;
More informationAuthor Statements and Copyright Assignment
Author Statements and Copyright Assignment Manuscript title: Corresponding Author: Before your manuscript (the Work ) can be considered for publication in FPM, each author must attest to his or her authorship
More informationBOARD OF DIRECTORS CHARTER
BOARD OF DIRECTORS CHARTER January 1, 2018 CAN_DMS: \106676478\23 BOARD OF DIRECTORS CHARTER Introduction The Board of Directors (the Board ) of Nutrien Ltd. (the Corporation ) is responsible for the stewardship
More informationCode for the Assessment and Management of Conflict of Interest
Updated January 2018 Purpose and Application: Code for the Assessment and Management of Conflict of Interest Complex relationships with for-profit and not-for-profit organizations and entities may by their
More informationHandbook for Handling Exempt Employees
Handbook for Handling Exempt Employees 1 Objective: The purpose of this handbook is to provide your timekeepers and approvers with the essential information that they will need to complete their normal
More informationBOARD OF DIRECTORS RYDER SYSTEM, INC. CORPORATE GOVERNANCE GUIDELINES
BOARD OF DIRECTORS RYDER SYSTEM, INC. CORPORATE GOVERNANCE GUIDELINES The Board of Directors of Ryder System, Inc. has adopted the following Corporate Governance Guidelines to assist the Board in the exercise
More informationEASTMAN CHEMICAL COMPANY. Corporate Governance Guidelines
I. Role of the Board of Directors EASTMAN CHEMICAL COMPANY Corporate Governance Guidelines The Board of Directors is elected by the stockholders to oversee management and to assure that the long-term interests
More informationOur Lady of Lourdes Health Care Services, Inc. and Affiliates POLICY NUMBER: AS0047CCP. PAGE NUMBER: 1 of 11
PAGE NUMBER: 1 of 11 ACCOUNTABILITY: President and Chief Executive Officer OBJECTIVES: RELATION TO MISSION: Our Lady of Lourdes, a Catholic Health System dedicated to its Franciscan Tradition of serving
More informationABCANN GLOBAL CORPORATION CORPORATE GOVERNANCE POLICIES AND PROCEDURES
ABCANN GLOBAL CORPORATION CORPORATE GOVERNANCE POLICIES AND PROCEDURES OCTOBER 12, 2017 LIST OF SCHEDULES A. Board Mandate B. Audit Committee Charter C. Compensation Committee Charter D. Nominating and
More informationPage: Page 1 of 5 Effective Date: January 27, 2004 Authorized By: President and CEO Function: Executive
Page 1 of 5 I. PURPOSE The Board of Directors has adopted the following Code of Business Conduct and Ethics (this Code ) for officers, directors and employees of RBC Bearings Incorporated (the Company
More informationCB&I SUPERVISORY BOARD CORPORATE GOVERNANCE GUIDELINES
CB&I SUPERVISORY BOARD CORPORATE GOVERNANCE GUIDELINES A. Mission of the CB&I Supervisory Board The primary goal of the Supervisory Board (the "Board") of Chicago Bridge & Iron Company N.V. ("CB&I") is
More informationCompliance with Laws, Rules and Regulations
R1 RCM Inc. (hereafter, R1 or the Company ) is committed to the conduct of its business in an ethical, legal, and transparent manner. In turn, the Company expects that all employees, contractors and vendors
More informationCorporate Governance Guidelines
Corporate Governance Guidelines July 2018 1. Role of the Board 3 2. Composition of the Board and Board Membership Criteria; Director Qualifications 3 3. Board Size 4 4. Independence 4 5. Change of Status
More informationFor personal use only
CONTENTS Introduction Role Access to Information and Independent Advice Composition and Meetings of the Committee Responsibilities in Respect of Remuneration Matters Responsibilities in Respect of Nomination
More informationCONFLICT OF INTEREST POLICY
CONFLICT OF INTEREST POLICY GENERAL POLICY STATEMENT No officer or employee may engage in any business or undertaking that is directly or indirectly in competition with or prejudicial to the interests
More informationJapan Radiological Society Guidelines on Management of Conflicts of Interest in Clinical Research. I. Purpose of formulation of guidelines
Japan Radiological Society Guidelines on Management of Conflicts of Interest in Clinical Research I. Purpose of formulation of guidelines The Japan Radiological Society was established with the aim of
More informationMETHANEX CORPORATION CORPORATE GOVERNANCE PRINCIPLES
METHANEX CORPORATION CORPORATE GOVERNANCE PRINCIPLES CORPORATE GOVERNANCE PRINCIPLES TABLE OF CONTENTS 1. OBJECT OF THESE CORPORATE GOVERNANCE PRINCIPLES 3 2. CODE OF ETHICS 3 3. BOARD RESPONSIBLITIES
More information