Ethics Office Notification of Lobbyist Contact

This form is to be used to report details of contact that you, as a CPS employee, have with a lobbyist. A copy of this will be sent to the Ethics Advisor as well as the Chief Procurement Officer.

Employee Name*

Please enter your name.

Employee Department*

Please enter the CPS department you work in.

Employee Email Address*

Please enter your email address.

Employee Phone Number*

Please enter your phone number.

Lobbyist Name*

Please enter the name of the lobbyist who contacted you.

Lobbyist Employer*

Please enter the company/organization that the lobbyist works for.

Lobbyist Client*

Please enter the company/organization that the lobbyist represented when they contacted you.

Lobbyist Email Address*

Please enter the email address of the lobbyist who contacted you.

Lobbyist Phone Number*

Please enter the phone number of the lobbyist who contacted you.

Purpose of Contact*

What was the purpose of the lobbyist contacting you?

Date of Contact*

Please enter the date that this contact took place.

Method of Contact*

How did the lobbyist contact you?

Select

Gifts Received?*

Was anything of value obtained from the lobbyist? (e.g., physical gifts, donations, favors, promises of employment)

Select

Gift Description

What was obtained?

Gift Value

What is the value of what was obtained?

Send me a copy of my responses

Privacy Notice|Report Abuse