Conflict of Interest Reporting Form - (Form COI Rev. 07/16)

A conflict of interest arises when an individual’s private interests (such as outside professional or financial relationships) might interfere with his or her professional obligations to the University of West Florida. Such situations do not necessarily imply wrong-doing or inappropriate activities. However,  in a university setting, they can compromise, or be perceived as compromising, important academic values, research integrity, or the University’s mission. This mandates that such conflicts or potential conflicts be disclosed and then managed, mitigated or eliminated.

In general, employees of the University of West Florida are permitted to engage in outside activities. The University of West Florida Conflict of Interest Policy, AC-11.02-05/13 and the Employee Code of Conduct, HR 15.02-06/16, provide guidance to employees seeking to engage in outside activities. In accordance with the Policies, employees are required to report any outside activity that involves or may involve a conflict of interest and obtain approval to participate in these activities prior to engaging in them.  

All employees, including student employees and OPS employees engaging in outside activities that involve or may involve a conflict of interest must complete this Conflict of Interest Form.

WHEN MUST A CONFLICT OF INTEREST FORM BE SUBMITTED?

A Conflict of Interest form must be submitted:

1.  Each time an employee plans to engage in any outside activity, whether compensated or not, which the employee should reasonably conclude

(a) may create or reasonably appears to create a conflict of interest;

(b) may otherwise interfere or reasonably appears to interfere with the full performance of the employee’s professional responsibilities or other institutional obligations; OR,

(c) may create conflict of time, which is defined as an outside activity (including consulting, public service or pro bono work) which interferes with the employee’s primary commitment of time, attention and intellectual energies to the University.

2.  Any time there is a significant change in an activity involving a Conflict of Interest that has previously been approved.

3.  For activities of a continuing nature,

(a)  For Academic employees, at the beginning of each academic year (therefore, for continuing activities, the form is only valid through August 7 of each year), and

(b) For Non-Academic employees, on or before July 1 of each year (therefore, for continuing activities, the form is only valid through June 30 of each year).

                         

Please review the Policies for a non-exhaustive list of activities that may constitute a conflict of interest which must be reported and for which prior approval in writing is required.

An employee’s failure to fully and properly report activities involving conflicts of interest or failure to follow any conditions imposed pursuant to the University’s approval of such activities, may be grounds for disciplinary action, up to and including dismissal.

BEFORE YOU PROCEED TO THE CONFLICT OF INTEREST FORM                 

In order to proceed to the form, you will be required to fill in the name(s) and e-mail address(es) of (1) your chair, director or supervisor; and (2) your dean, AVP, or Department Head; and (3) your Vice President, all as applicable.  Be sure to click on the blue floppy disk icon to save the information before proceeding. 

As you fill out the form, be sure to save your information by clicking on the “save progress” button at the end of each page.   At the end of the form, you will be asked for a signature.  At the point that you are ready to submit the form, you should type your name on the signature line and click “sign electronically.” The form will automatically route to the supervisor(s) you have designated. 

If you do not click “sign electronically,” but have saved your information, the form will be available for you to complete and process by clicking “draft forms” on the dynamic forms starting page.

PROCEED TO THE CONFLICT OF INTEREST FORM

If you are a Dean, AVP, or Department Head, click here to proceed to the form (1 approval signature).

If you are a Chair, Director, Supervisor, click here to proceed to the form (2 approval signatures)

All others, click here to proceed to the form (3 approval signature)