CME Event

Virtual CME events are strongly encouraged and preferred. In this time of COVID-19, if it is a necessity that a CME educational activity be held in person, whether on campus or at any other locations off campus, any IUSM MD, faculty or staff member organizing the event is required to complete a request form and safety plan.

If the event will involve 25 or more participants (inclusive of event organizers, staff, and participants), the event planning chair is required to complete the Indiana University Event Request Committee approval process .

If 24 or fewer participants (inclusive of event organizers, staff, and participants), the event planning chair is required to complete the IU School of Medicine CME In-Person Event Request form below. This outlines responsibilities of the event organizer(s) and requests detailed information and an attestation. Activity planners are encouraged to apply with as much lead time as possible, maybe even a month. People involved will do their best to review promptly, but this is a multi-step process. The requestor will be notified of the outcome by email.

In either case, CME’s final approval of an in-person event will be contingent upon proof of review and approval of the event.

Clients external to IU will work with the CME office to go through the approval process.

If you are looking for the request form for student events, see the IUSM Co-Curricular Event Request Form .

REQUESTOR INFORMATION

Name*

Requestor Campus

IU Email Address*

Department or Organization*

Phone*

Program*

EVENT INFORMATION

Event Title*

Event Type*

Event Description*

Explain the reasons this educational activity cannot be done effectively in a virtual setting.*

IUSM Campus Hosting Event

Attendee Type*

Select all that apply

Student
Faculty
Staff
Public

Describe public or name of outside organization

Start Date*

Start Time*

: HH

MM

End Date*

End Time*

: HH

MM

Reoccurring events (i.e. meets every Thursday) must be submitted for each occurrence. Multi-day but consecutive events may be submitted with one request by choosing the appropriate start and end date.

Number of Attendees (inclusive of event organizers, staff, and participants)*

Is this event taking place on or off campus?*

On campus
Off Campus

Location*

(e.g. outside location, building name and room number for on-campus events, or venue name and address for off-campus events)

Does this event involve an outside organization?*

Yes
No

Name of Organization*

Will virtual experiences be provided for those who cannot or should not attend in person?*

Yes
No

Please describe virtual experience*

Alternate & Cancellation Plans*

If public health guidance requires that your event may no longer be held, describe how/if you would proceed virtually or cancel the event. Be sure to include the necessary steps and procedures required to accomplish this

SAFETY PLAN

Social Distancing (requirement of 6 ft. per person in all directions)*

Please provide information on how social distancing will be maintained during the event. Briefly describe seating arrangements, attendee circulation during the event, registration tables, line spacing as people enter and exit rooms, restroom areas, and other high traffic flow areas. Diagrams are not required, but may be attached if useful to explain.

Room Capacity Prior to Covid-19*

Room Capacity After Covid-19*

To adhere to social distancing regulations, number of people in a room (including learners, presenters and facilitators) should be 50% or less than the original room capacity. If number of people in the event exceed 50% of original room capacity, please provide a diagram of how people will be spaced to adhere to 6 ft. social distancing.

Upload

Masks/Cleaning/Sanitation:*

Please describe the availability of masks, hand sanitizers and cleaning supplies, and disinfectants for use by attendees during the event. Provide information on the cleaning/sanitation protocols during the event and after, including frequency and who is responsible. Provide information on the sanitation of venue surfaces, seating and equipment (computers, A/V equipment, microphones, etc.).

Communication/Signage*

Please provide information on how COVID-19 safety procedures will be distributed to event attendees and the signage to be used at the event to provide guidance to attendees.

Staffing*

Who will staff event and what are their roles? In addition, provide information on who is responsible for set up, cleaning/sanitation and ensuring social distance is maintained.

Registration/Attendees*

Please describe how registration/attendance will be handled, or at a minimum, how a list of participants will be collected. A list of participants must be collected and kept for 21 days.

Food/Beverage*

Food and beverages are only allowed for events lasting longer than 3 hours, with fewer than 25 participants. Food must be individually boxed or pre-packaged and eaten outdoors with appropriate 6-feet of physical distancing. If your event meets this criteria, please provide information regarding food and beverage service during the event.

ACKNOWLEDGEMENT

By typing my name below, I acknowledge that I am responsible for this event and that:

All participants will wear cloth face coverings in public spaces, face-to-face meetings and all in-person activities while on a campus or off.
All participants will follow COVID-19 room capacity limits as set by the campus or external venue and maintain 6 feet of personal distance.
Participants will not share objects (ex. pens, serving utensils).
All participants will practice appropriate hand hygiene and respiratory etiquette (no hand shaking, coughing into elbow, etc).
The space will be appropriately cleaned/disinfected prior to and following the event.
Only individually boxed or pre-packaged food and beverages can be provided for events lasting longer than 3 hours, with fewer than 25 participants, and if food is eaten outdoors with appropriate 6-feet of physical distancing.
A list of all participants will be collected and kept for 21 days after the event.
Outdoor events are strongly encouraged whenever possible since they reduce the risks of viral transmission compared to indoor events.
Events must comply with current guidance from CDC, Indiana State Department of Health, State rules and host University policy. Events will never exceed local and state limitations on group size.
IU (or host campus) travel and visitor restrictions will be adhered to at all times.
Based on public health guidance, state, local, and/or university policy, this event may be cancelled at any time.

Type Your Name*

Today's Date*

Teaching Portal

IUSM CME In-Person Event Request Form

REQUESTOR INFORMATION

EVENT INFORMATION

SAFETY PLAN

ACKNOWLEDGEMENT