CRHFT & DSFS Decision Makers: Annual Declaration Form 2023

This form is solely for the purpose of making the annual declaration of interests for all colleagues classed as decision makers within CRHFT & DSFS. You have been issued the link to this form because CRHFT/DSFS class you as such. For guidance on what classifies as an interest please refer to the document attached to the email which provided you with this link.

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* 1. Full name

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* 2. Role

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* 3. Designation

CRHFT Governor

CRHFT Executive Director

CRHFT Non-executive Director

DSFS Board member

Clinical Staffing

Non-clinical/Corporate Staffing

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

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* 5. Permission to publish (please choose 'yes' unless there are exceptional circumstances; for example in doing so would risk harm.) Please note that any No responses does not mean your interest will automatically not be published if your reasoning does not confirm why disclosure could give rise to a real risk of harm or is prohibited by law.

Yes

No - Please state the reason why

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* 6. Do you have an interest to declare?

Yes

No - this will be recorded as a Nil declaration