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Child Death Review Case Reporting Data Use Agreement Addendum
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2017-08-01 10:00 AM - Commissioners' Agenda
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Child Death Review Case Reporting Data Use Agreement Addendum
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Last modified
1/16/2018 2:48:20 PM
Creation date
1/16/2018 12:12:36 PM
Metadata
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Template:
Meeting
Date
8/1/2017
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
q
Item
Request to Approve a Resolution to Authorize an Amendment to the Child Death Reporting System Data Use Agreement between the Kittitas County Public Health Department and the Michigan Public Health Institute
Order
17
Placement
Consent Agenda
Row ID
38579
Type
Agreement
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8. I understand that my failure to comply with this Agreement may result in disciplinary <br />action up to and including termination of my employment. I understand that violating <br />applicable laws and regulations may lead to other legal penalties imposed by the judicial <br />system, such as fines and/or imprisonment. <br />9. 1 understand and accept that signing this agreement is a condition of my employment and <br />those obligations under this Agreement will continue after termination of my <br />employment. <br />Employee Signature: <br />Print Employee Name: <br />Supervisor Signature: <br />Print Supervisor Name: <br />Date: <br />Date: <br />I understand that it is my responsibility to read the Privacy and Confidentiality Policy and any associated <br />policies and understand its terms. If I have any questions concerning information contained in the policy, I <br />will bring them to the attention of my supervisor, manager, or Privacy Officer. <br />12 <br />
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