UNIVERSITY OF SOUTH FLORIDA REPORT OF OUTSIDE ACTIVITY
Employee's Name				Employee's Title
Employee's Department
Employee Type: Faculty (12 month) Faculty (9 month) A&P USPS							FTE
Name of Employer or Recipient of Services:		Location of Proposed Employment or Activity:					Funding Source, if compensated:
Anticipated Dates of Activity from to					Number of Days/wk Avg Number of Hrs/Wk
Nature and Extent of Activity:
During the course of this activity, do you intent to use the facilities, equipment, or services of the University? yes no If yes, please specify:
Must you waive patent rights as a condition of this outside activity? yes no If yes, prior approval by the USF Vice President for Research is required.
Signature of Vice President for Research			Approved Disapproved					Date
Does this activity include employment with another state agency? yes no If yes, dual compensation approval must be obtained prior to beginning employment.
Have you previously filed report(s) of outside activity for the same academic year: yes no (Note: A new request must be filed each July 1 if period of activity is in excess of one fiscal year.) If yes, what is the total number of hours of outside activities?
I certify that the outside activity reported herein does not constitute a conflict of interest and will not interfere with my regular employment at the University of South Florida.
Employee's Signature						Date Received by Chair/Supervisor:
Reviewer	Reviewer's Signature			Report Accepted		Report for Accepted/ Conference Requested			Date
Chair/Supervisor
Dean/Director
Provost/Vice President or Designee
Date of Conference, if necessary				Result of Conference: Approved Disapproved
Distribution: Original to Provost/Vice President; copies to Human Resources, College/Division, and Employee

University of South Florida

Report of Outside Activity

OUTSIDE ACTIVITY means "any private practice, private consulting, additional teaching or research or other activity, compensated or uncompensated, which is not part of the employee's assigned duties for which the University has provided no compensation." The Florida Board of Education (FBOE) and the University do not intend to discourage an employee for engaging in outside activity in order to increase professional reputation, service to the community, or income. However, notification and an opportunity to discuss are necessary due to the special obligations and responsibilities of public employees bound by the State of Florida Code of Ethics and dual compensation regulations, in addition to the responsibility for full and competent performance of all duties pertinent to University employment.

YOU MUST SUBMIT THE ATTACHED REPORT OF OUTSIDE ACTIVITY FORM IF, DURING A PERIOD IN WHICH YOU HAVE AN APPOINTMENT WITH THE STATE UNIVERSITY SYSTEM:

· You propose to engage in any compensated or professional outside activity within the above definition or outside activity, AND/OR

· You propose to engage in any outside activity, compensated or uncompensated, which you should reasonably conclude

1. May create or reasonable appear to create a conflict of interest, OR
2. May otherwise interfere or reasonably appear to interfere with the full performance of your professional responsibilities or other institutional obligations.

IN ADDITION, YOU MUST:

· Submit the report to your supervisor prior to engaging in the subject activity;

· Refrain from using facilities, equipment, supplies, services or staff of the University in connection with such outside activities without prior approval of the Vice president, which may be conditional upon reimbursement;

· Take reasonable precautions to ensure that the outside employer or recipient of your services understands that you are engaging in such outside activity as a private citizen and not as an employee, agent, or spokesperson of the University.

COMPLETING AND PROCESSING THE REPORT OF OUTSIDE ACTIVITY FORM

· Fill in all blanks. If not applicable to your report, mark N/A.

· Make sure that the writing or typing is legible.

· Your Chair/'Supervisor will review and forward the form. At any level or review a conference may be requested in the event that it appears that this activity may interfere with your obligations and responsibilities or create a conflict or interest.

· If the matter is not previously resolved, the Vice President shall determine whether the outside activity creates a conflict of interest or otherwise interferes with your professional or institutional responsibilities. You shall be notified of the University's determination no later than three weeks from the date the matter was referred to the Vice President.

· If you desire to challenge the University's determination and are covered by the collective bargaining agreement, you may request an expedited arbitration hearing under Article 20, Grievance Procedure. Out-of-unit faculty and A&P employees may seek remedy through the USF Grievance Procedure.

· You may engage in such outside activity pending the decision of the arbitrator or hearing officer. If the arbitrator or hearing officer determines that there is a conflict of interest or other interference with your professional or institutional responsibilities, you shall cease such activity immediately and turn over to the University any compensation earned.