AA STD Dispariies - Confidentiality Agreement

African American STD Disparities Health Communication Project

#0920-0798

ATTACHMENT 11

CONFIDENTIALITY AGREEMENT

Form Approved

OMB No. 0920-0798

Expiration Date: 01/31/2011

RECRUITMENT STAFF

CONFIDENTIALITY AGREEMENT

Ensuring the confidentiality of all reports, records, and files containing client names and/or identifying information is critically important to the African American STD Disparities Health Communication Project.

I, ___________, agree to provide recruitment services for the benefit of RTI in conjunction with the RTI project, African American STD Disparities Health Communication Project.

Further, I

____ hereby accept all duties and responsibilities of performing specified recruitment tasks and will do so personally in accordance with the training and guidelines set out by RTI;

____ will not engage the services of another person for the purpose of performing any recruitment or other field tasks for me without prior, written approval from the recruitment leader;

____ promise to perform only the recruitment tasks specified by the recruitment leader and will not conduct any auxiliary recruitment without the approval of the recruitment leader;

____ agree to treat as confidential and proprietary to RTI any and all survey instruments, materials, and documentation provided or accessed while employed on this project;

____ am aware that the survey instruments completed form the basis from which all the analysis will be drawn, and therefore agree that all work completed on the project will be of high quality and performed in compliance with project specifications;

____ agree to treat as confidential all information secured during recruitment or obtained in any project-related way during the period while employed by RTI;

____ agree to keep all client records as well as any identifying information closed and locked in accordance with the principles set forth by the recruitment leader;

____ agree to act professionally in a manner that will obtain the respect and confidence of all individuals from whom data will be collected and not betray their confidence by divulging information obtained to anyone other than authorized representatives of RTI;

____ agree to never discuss sensitive office issues or records outside of the office setting, nor confirm or deny any specific person’s participation in the study;

____ agree to report any known or suspected breaches of confidentiality to the recruitment leader; and

____ understand that my obligations to maintain the confidence and privacy of the project and participants’ personal information under this agreement will survive the termination of any assignment and my affiliation with RTI.

Signature

Date