Attachment 5

Recruitment Staff Agreement of Confidentiality

Ensuring the confidentiality of all reports, records and files containing client names and/or identifying information is critically important to the Perceptions of Health Risk from Smokeless Tobacco Products and Nicotine Replacement Therapy among Pregnant Women and Women Planning a Pregnancy

I, _______________________, agree to provide recruitment services for the benefit of RTI in conjunction with the RTI project, Perceptions of Health Risk from Smokeless Tobacco Products and Nicotine Replacement Therapy among Pregnant Women and Women Planning a Pregnancy

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 RTI;

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

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

____ am aware that the information collected on the forms are very important, 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-related project documents and records, as well as any identifying information, closed and locked in accordance with the principles set forth by RTI;

____ agree to act professionally in a manner that will obtain the respect and confidence of all individuals participating in this project from whom information 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 project;

____ agree to report any known or suspected breaches of confidentiality to RTI; 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