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Disclosure Review and Management Plan Form

Disclosure Review and Management Plan Form

Part 4: Disclosure Review and Management Plan

Dean/Administrative Supervisors:

Deans (in consultation with their department heads where appropriate) and administrative supervisors will complete this section when an employee discloses a conflict(s) by answering 'yes' to any question on the COI/COC disclosure form. Please review and verify the information submitted on the disclosure form, provide your recommendation and proposed management plan, and submit completed forms to the Vice President/President responsible for your unit; include a list of employees who have not submitted a disclosure form.

Type of Potential or Actual Conflict(s):

Mark all that apply to indicate type of conflict(s):
Type of Conflicts
Dean/Administrative Supervisor Signature