ACOEM Webinar Proposal

ACOEM Webinar Submission Form

ACOEM welcomes your ideas for future webinars! Webinars are currently conducted via Zoom, one hour in length, with the recommended day and time on Tuesdays at Noon CST. There is flexibility with the length (up to 1.5 hours), day and time. If you are interested in proposing a longer activity, please email us at webinars@acoem.org.
Primary Contact for Webinar:*

First NameLast Name
Email:*
example@example.com
On behalf of (if applicable):
ACOEM Section or Component
If this is a section webinar, please indicate who can attend:

Section Members onlyAll ACOEM Members onlyACOEM Members (free) and ACOEM Non-members (TBD fee)
What date would you like to present this webinar (please do not promote any dates until confirmed by ACOEM):

MonthDayYear
Date
What time would you like to present this webinar (Please use Central Time):

:HourMinutesAM/PM Option
Are you requesting CME from ACOEM for this webinar?*

YesNo
Webinar Title:*
Brief Description of Webinar Content (to be used in marketing):*
i.e. what makes this event unique?; what is appealing about this webinar?
Learning Objectives (need 2-3 objectives which should follow, "Upon completion of this activity, participants should be able to): *
For more information on writing learning objectives, please click here.
Identify the practice gaps that this webinar will address:*
Find more about practice gaps by visiting the ACCME website here: https://www.accme.org/resources/video-resources/accreditation-requirements/addressing-practice-gaps
Webinar Faculty

ACOEM staff will request disclosure forms and media release forms from all faculty once the webinar is confirmed.
Faculty 1: Name, Email, Credentials, Position
Faculty 2: Name, Email, Credentials, Position
Faculty 3: Name, Email, Credentials, Position
Faculty 4: Name, Email, Credentials, Position
Who is the target audience for this webinar?

OEM PhysiciansUrgent Care PhysiciansOEM Physician Assistants, Nurse Practitioners, Other Advanced PractitionersOccupational Health NursesIndustrial HygienistsSafety Professionals
Which of the following formats/methods will you use to engage attendees?*

Q & A at endBreakout roomsPoll questionsPanel discussionAdd in video content
In the context of which of the following OEM competencies will this webinar be developed? Click all that apply.

Clinical Occupational and Environmental MedicineOEM Related Law and RegulationsEnvironmental HealthWork Fitness and Disability ManagementToxicologyHazard Recognition, Evaluation and ControlDisaster Preparedness and Emergency ManagementHealth and ProductivityPublic Health, Surveillance, and Disease PreventionOEM Related Management and Administration
Should be Empty:

ACOEM Webinar Submission Form

Webinar Faculty