Session Checklist

Rutgers Regularly Scheduled (Grand Rounds) Activities

This checklist is designed to assist you with gathering the necessary paperwork to document compliance with

the continuing education (CE) requirements. Please use this document for each session held and maintain a file

for preparation of compliance reporting and file audit.

Note – Documenting evidence of compliance is mandated by Rutgers’ CE accrediting entities: ACCME, ANCC and ACPE.

Series Title: Series Activity Code:

Series Type: Grand Rounds Lecture Series Case Conferences Session DateTime:

Tumor Boards M&M Journal Club

Session Title: Session Presenter(s):

Did this session receive commercial support? Yes No If yes, please completeAppendix A.

Documents/Materials / Essential Elements / Notes
Brochure, Flyer, Announcement / Department Providership Statement
Title
Date/Time/Location
Faculty w/ Credentials
Target Audience
Session Learning Objectives or Series Objectives
New Accreditation Statement w/ Joint Accreditation Logo
Credit Designation Statement(s)
Physician Nurse Pharmacist
Maintenance of Certification Statement
N/A ABA ABIM ABPath
Presenter(s) Disclosure Declaration(s)
Off-Label Disclosure Generic Statement
Activity Director(s)/Planning Committee/Content Reviewer
Disclosure Declaration(s)
Content Reviewer Identified
How are all learners notified of the information above prior to the start of the activity?
Brochure/Flyer/Announcement Emailed to Potential Learners[cannot be only method]
Brochure/Flyer/Announcement Displayed w/ Sign-In Sheet [minimum requirement]
Posting/Poster at Specific Locations Learners [cannot be only method]
Information Presented in Opening Remarks/Slide Presentation
Other; Specify:
Educational Materials / Presentation
Abstract, Syllabus Material, Other Handouts, etc.
Copy of Case Histories (applies to Case Presentations)
Copy of Journal Article (applies to Journal Clubs)
Speaker Agreement / SpeakerResponsibilities Agreement
Speaker Disclosure/ Potential COI Identified *
Yes No / Signed Disclosure Forms from ALL Speakers, Moderators, and Discussants
(Including house staff presenters)
* A potential conflict of interest (COI) exists if a speaker indicates on his/her disclosure form that he/she has a financial relationship with any commercial interest.
Documents/Materials / Essential Elements / Notes
Content Validation and COI Resolution * / Completed Content Review and Validation Form
Signed Content Reviewer Letter
On File **
Reviewer Disclosure Form
On File **
* The activity director or planning committee member (who has reported no financial relationships) must validate the CE content and resolve the speaker’s COI through a review of the speaker’s presentation materials and corrective action must be taken prior to the delivery of the presentation, if necessary.
** Planning committee members’ content review letter(s) and disclosure form(s) should be submitted with the CE application.
Attendance Record / Departments must maintain an attendance record at each session and report total attendance accurately on end-of-year roster.
ACPE and MOC Attendance Record / Call CCOE for specific instructions for attendance recording and reporting.
Speaker Honorarium and Travel
Reimbursement / Departments must report speaker honorarium and travel reimbursement on
session reports.
Quarterly Documentation Requirements(End of Each Quarter - Due October 31st, January 31st,, April 30th, and July 31st)
Sessions Reporting Summary / List of Sessions for the Current Reporting Period
Use CCOE Excel Spreadsheet Template
Departments must provide a complete listing of sessions held in order to validate the total CE credit awarded on the end-of-year roster.
Brochure, Flyer, Announcement / Brochure/Flyer/Announcement for ALL sessions offered during the quarter
Combine all into one PDF
Speaker Disclosure / Signed Disclosure Forms from ALL Speakers, Moderators, and Discussants
(Including house staff presenters) for ALL sessions offered during the quarter
Upcoming Schedule / Program Schedule for Upcoming Sessions
Can be Included with Current Sessions Reports Spreadsheet
Semi-Annual Documentation Requirements (End of 2nd Quarter- Due January 31st and End of 4th Quarter - Due July 31st)
Evaluation Method/Report / Evaluation Instrument, e.g., form
Evaluation Summary Report
Annual Documentation Requirements (End of 4thQuarter- Due July 31st)
Electronic Attendance Roster / Roster Spreadsheet
Use CCOE Excel Spreadsheet Template
Departments must furnish a complete and accurate list of learners’ attendance consistent with department attendance method(s) and sessions’ reports.

Appendix A

Commercially Supported Session Checklist

Complete this sheet when a SESSION IS FUNDED by an educational grant from industry (e.g., pharmaceutical/device manufacturer).

Series Title: Series Activity Code:

Session Title:

Session Date & Time:

Documents/Materials / Essential Elements / Notes
Funding Request Correspondence and Supporting Materials / Grant Request Cover Letter
On File w/ CCOE
Grant Proposal including Budget
On File w/ CCOE
Application
On File w/ CCOE
Related Correspondence (e.g., Award Notification)
On File w/ CCOE
Letter of Agreement / Signed Letter(s) of Agreement
On File w/ CCOE
Speaker Honorarium and Travel
Reimbursement / Copy of Request for Checks, Travel Expense Forms, and/or Other Documentation of Speaker Honorarium and Travel ReimbursementTransactions
Not Applicable
All Other Session Expenses / Copy of Purchase Orders, Request for Checks, Invoices, Institutional Accounting
Transactions, and/or Other Recording of Expense Transactions
Not Applicable
Reconciliation / Department Financial Reconciliation Report of Session Expenditures
Use CCOE Spreadsheet Template
Grantor Financial Reconciliation Report and Associated Materials
On File w/ CCOE

RSS Session Checklist Page 1 of 3 FY19