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Request Gift/Benefit approval

Gift, hospitality or benefit Register

Recipient’s Name: *

Recipient's Email: *

Recipient's Position: *

Recipient's Directorate: *

Date the offer for a gift, hospitality or benefit was received: *

Describe the gift, hospitality or benefit offered: *

Estimated or actual Value: *

If the gift, hospitality or benefit is valued less than $50 you are not required to declare it. The item is considered Token and is not required to be registered.

Explain the reason the gift, hospitality or benefit offered: *

How can the gift, benefit or hospitality benefit Barwon Health? *

Name of person (donor) making the offer: *

Position of person making the offer: *

Name of organisation making the offer: *

Type of organisation: *

Is the donor making the offer a business associate? *

Do you consider that by accepting the gift, hospitality or benefit, any of these could occur? *

Result in an actual, potential or perceived conflict of interest for myself
Bring myself, the organisation or the public sector into disrepute
Result in personal gain
I do not consider any of these apply

Please select one of the following *

Do you seek permission to ACCEPT the offer?
Did you accept the offer?
Do you intend to, or did, DECLINE the offer?

Is there a gift involved? *

Do you intend to: *

Validate Email

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Traditional owners flags We, Barwon Health, acknowledge the Traditional Owners of the land, the Wadawurrung people of the Kulin Nation. We pay our respects to the Elders both past and present.

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