SUBMISSION CHECKLIST FOR COMPLETED GUIDELINES

Note. All documentation should be sent electronically if possible

Title of Standards & Guideline
Click here to enter text. /
Guideline Development Group Lead
Name / Job & Place of Work / Email / Contact Telephone
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Guideline Development Group Members
Name / Job & Place of Work / Email / Contact Telephone
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text / Click here to enter text. /
Click here to enter text. / Click here to enter text / Click here to enter text / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text /
Click here to enter text / Click here to enter text. / Click here to enter text / Click here to enter text. /
Click here to enter text. / Click here to enter text / Click here to enter text. / Click here to enter text /
Click here to enter text / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text / Click here to enter text / Click here to enter text /
Click here to enter text / Click here to enter text / Click here to enter text / Click here to enter text /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text / Click here to enter text. /
Guideline Scope & Purpose / Comments
Completed Guideline / Attached☐
Guideline Development Group Checklist / Attached☐
Record of Development / Comments
Dates and Minutes of Meetings / Attached☐
Summary Form from Systematic Literature review / Attached☐
Confirmed details of user involvement
(include name position and type of involvement) / Click here to enter text. /
Feedback Summary from Presentation / Attached☐
Feedback Summary from Consultation / Attached☐
Feedback Summary from External Review / Attached☐
Dissemination & Implementation of Guideline / Comments
List presentations of the guidelines done by GDG / Click here to enter text. /
List any publications/conference abstracts pending or completed / Click here to enter text. /
Which implementation aids are attached? Please list / Click here to enter text. /
Independence and Conflicts of Interest
Has the group received any funding to complete the guideline? / It is anticipated that funding is not usually required
Conflicts of Interest / Please attach Conflicts of Interest forms for all members of the group
Declaration by GDG Lead
Name / Click here to enter text. /
Signature / Click here to enter text. /
Date / Click here to enter text. /

Cheshire and Merseyside Palliative and End of Life Care Network Audit Group – Submission Checklist – April 2014

1