Conflict of Interest Declaration Form

Use this form to declare an actual, potential or perceived conflict of interest.

Declaring a conflict does not necessarily mean you have done anything wrong. BSL First uses this information to make sure decisions, teaching, assessment, quality assurance, complaints and investigations remain fair and impartial.

Section 1: Person making the declaration

First Name

Last Name

Email address

Phone number

Course, assessment, learner, complaint, appeal, investigation or area affected

Section 2: Type of conflict

Section 3: Details of conflict

Please explain the conflict or possible conflict.

Has any action already been taken?

Yes

Please explain what action has already been taken.

Section 4: Proposed mitigation

Please add any further details about proposed mitigation.

Section 5: Evidence

Upload any relevant evidence

Choose File

Section 6: Declaration

I confirm that the information I have provided is accurate to the best of my knowledge.

I understand that I must update BSL First if the situation changes or if I become aware of another conflict of interest.

I understand that BSL First will review this declaration and may decide what action or mitigation is required.

I understand that BSL First will process my personal data, and any sensitive information included in this form, to review and manage the conflict of interest.