6) QA Checklist

Quality Assurance Checklist

A UKHCCEC staff member, activity director, moderator or other qualified designee should complete this form.
Activity Title*
Activity Date*
CE Representative (name of individual completing this form)*

First NameLast Name
Number of speakers to review:

1234

Speaker*

First NameLast Name
Presenter disclosed relevant financial interest via handout*

YesNo
Presenter disclosed verbally:*

Presenter had nothing to disclosePresenter had the following to disclose
Name of Commercial Interest*
Relationship*
Compensation Received*
Speaker checklist*

Used the generic term when referring to drugsIf used a trade name, compared and contrasted several productsPresentation was objective and fairly balanced** Slides and written materials do not contain any trade names or logos **Participants were actively involved in the learning process through group discussion, Q and A, posttest, case study, simulation and/or problem-solving exercises
Additional Comments:

Speaker*

First NameLast Name
Presenter disclosed relevant financial interest via handout*

YesNo
Presenter disclosed verbally:*

Presenter had nothing to disclosePresenter had the following to disclose
Name of Commercial Interest*
Relationship*
Compensation Received*
Speaker checklist*

Used the generic term when referring to drugsIf used a trade name, compared and contrasted several productsPresentation was objective and fairly balancedParticipants were actively involved in the learning process through group discussion, Q and A, posttest, case study, simulation and/or problem-solving exercises
Additional Comments:

Speaker*

First NameLast Name
Presenter disclosed relevant financial interest via handout*

YesNo
Presenter disclosed verbally:*

Presenter had nothing to disclosePresenter had the following to disclose
Name of Commercial Interest*
Relationship*
Compensation Received*
Speaker checklist*

Used the generic term when referring to drugsIf used a trade name, compared and contrasted several productsPresentation was objective and fairly balancedParticipants were actively involved in the learning process through group discussion, Q and A, posttest, case study, simulation and/or problem-solving exercises
Additional Comments: