Use this one page form if you are a Decision Maker and have 'nothing to declare' for your annual declaration.
Gifts or hospitality - please use https://www.surveymonkey.co.uk/r/SXVDHFX
Shareholdings, patents, loyalty interests, donations, outside employment and clinical private practice, sponsored posts, events or research - please use https://www.surveymonkey.co.uk/r/CRHDeclarationofInterest

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* 1. Full name

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* 2. Role

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* 3. Designation

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* 4. Decision Maker (BoD, CoG, DSFS Board member, consultants with management roles, agenda for change 8d and above, those directly involved in recruitment, and those deemed as 'authorised signatures'.)

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* 5. Division (Governors and Non-Executive Directors please use Corporate Division)

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* 6. Permission to publish (please choose 'yes' unless there are exceptional circumstances; for example in doing so would risk harm.)

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* 7. I have read the Chesterfield Royal Hospital NHS Foundation Trust's 'Managing Conflicts of Interest' policy and confirm that (see option below)

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