Conflict of Interest Declaration

Please follow the instructions below:

Complete this from if there are any real or potential conflict of interests
Complete this form if you work for another organisation
Management to determine and record how to manage any conflict
Details must be recorded in the Conflict of Interest Register

Create your Conflict of Interest numbere.g. 06JAN23RF - this means you became aware of this conflict on the 6th of January 2023 and your name is Rose Farfalla

WORKER INFORMATION

First Name *

Surname *

Job Title *

CONFLICT OF INTERESTS DETAILS

What is the nature of this conflict of interest? *

Has the conflict occurred? *

YesNo

If no, when it is possible or likely to occur?

List persons name, the connection to you and why the conflict may occur.e.g. Josephine, my daughter, we may work a shift together. Another example would be my Aunty is using HappinessFirst services, so the conflict is I may be supporting her.

If the conflict is because you work or volunteer at another organisation, please list other employers and type of work.

MITIGATION

What could be the solution to implement to reduce the conflict of interest?

DECLARATION

First name *

Surname *

Signature *

Draw signature|Type signatureClear

Date Signed *

A copy of this will be emailed to you. Email: