Student Handbook
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Workforce Confidentiality Agreement
IMPORTANT: Please read all sections. If you have questions, please seek clarification before signing.
- Confidentiality of Student Information:
I understand and acknowledge that:
- Services provided to students are private and confidential;
- Students provide personal information with the expectation that it will be kept confidential and only be used by authorized persons as necessary.
- All personally identifiable information provided by students or regarding medical services provided to students, in whatever form such information exists, including oral, written, printed, photographic and electronic (collectively the “Confidential Information”) is strictly confidential and is protected by federal and state laws and regulations that prohibit its unauthorized use or disclosure; and
- In my course of employment/affiliation with SUNY College at Brockport, I may be given access to certain Confidential Information. Disclosure, Use and Access
- I agree that, except as authorized in connection with my assigned duties, I will not at any time use, access or disclose any Confidential Information to any person (including, but not limited to co-workers, friends and family members). I understand that this obligation remains in full force during the entire term of my employment/affiliation and continues in affect after such employment/affiliation terminates.
- Confidentiality Policy
I agree that I will comply with confidentiality policies that apply to me as a result of my employment/ affiliation.
- Return of Confidential Information
Upon termination of my employment/affiliation for any reason, or at any other time upon request, I agree to promptly return to SUNY College at Brockport any copies of Confidential Information then in my possession or control (including all printed and electronic copies), unless retention is specifically required by law or regulation.
- Periodic Certification
I understand that I will be required to periodically certify that I have complied in all respects with this Agreement, and I agree to so certify upon request.
- Remedies
I understand and acknowledge that:
- the restrictions and obligations I have accepted under this Agreement are reasonable and necessary in order to protect the interests of patients and SUNY College at Brockport, and
- my failure to comply with this Agreement in any respect could cause irreparable harm to students and SUNY College at Brockport.
I therefore understand that SUNY College at Brockport may prevent me from violating this Agreement by any legal means available, in addition to disciplinary measures which may result in sanctions in accordance with applicable policies and collective bargaining agreements.
Signature: ____________________________ Date: ________________
Printed Name: _____________________________________________
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