Page 19 - Ombudsman Participant Manual Optimized_Neat

Interest Screening
Conflict of

All ombudsman staff and volunteers must complete a Conflict of Interest Screening form to determine if they have any

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individual conflicts of interest that could interfere with their duties as an ombudsman. the answers to the questions

indicate a conflict, then a remedy or solution to the conflict must be proposed and submitted to the State Long Term Care

Ombudsman office. The State Long Term Care Ombudsman will review the remedy to the conflict and approve or deny the

remedy.

In addition to the Conflict of Interest Screening form depending on the answers to the questions, each person must

complete a “Conflict Identified” or “No Conflict Identified” form. All of these forms must be signed by the ombudsman staff
or volunteers as well as their supervisor or mentor.
These forms are available under the Attachments tab on the left-hand side. Click on the paper clip to view all
downloadable and fillable documents. Once you click on a document in the list you can view, complete or save the
documents. When you are finished viewing, completing, or saving the documents, click on the small x in the upper
right-hand corner to close the document and return to the manual.

Office of the LTC Ombudsman
Office of the LTC Ombudsman
Version 1.0 September 2020
Version 1.0 September 2020
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