HomeMy WebLinkAboutAffiliation AgreementAFFILIATION AGREEMENT
This Agreement is made and entered into between the University of Washington School of Public Health ("School"), located
at Seattle, Washington, and Kittitas County Health Department ("Training Site"), located at Ellensburg, Washington. The purpose of
this Agreement is for Training Site, which is committed to training health care professionals, to provide desirable practicum experiences
and facilities for School's students. In consideration of the murual covenants and agreements contained herein, School and Training
Site agree as follows:
GENERAL PROVISIONS
1. School and Training Site agree that contemporaneous with or following execution of this Agreement and within the scope of its
provisions, School may develop letter agreements with Training Site to formalize operational details of the practicum experience . These
details include, but are not limited to, the following:
• Beginning dates and length of experience (to be murually agreed upon at least one month before the beginning of the
practicum experience);
• Number of srudents eligible to participate in the practicum experience;
• Specific days, hours and locations for the practicum experience;
• Specific learning objectives and performance expectations for students;
• Specific allocation of responsibilities for the Liaison and Practicum Site Supervisor referenced elsewhere in this Agreement;
• Deadlines and format for student progress reports and evaluation forms.
2 . Any such letter agreements will be considered to be attachments to this Agreement, will be binding when signed by authorized
representatives of each party, and may be modified by subsequent letter agreements signed by authorized representatives of each party.
3. School and Training Site will jointly plan the practicum experience and jointly evaluate students. Exchange of information will
be maintained by on-site visits when practical and by letter or telephone in other instances.
4. School and Training Site will instruct their respective faculty, staff, and srudents participating in the practicum experience, to
maintain confidentiality of student and client information as required by law and by the policies and procedures of School and Training
Site.
5 . There will be no payment of charges or fees between School and Training Site.
6 . There will be no unlawful discrimination against any program participant or applicant covered under this Agreement because
of race, color, religion, national origin, age, handicap, starus as a Vietnam era or disabled veteran, sex, or sexual orientation, nor will
School or Training Site engage in such discrimination in their employment or personnel policies.
§CHOqL'S RESIlONSIBILITIES
7. School will provide information to Training Site concerning its curriculum and the professional and academic credentials of its
faculty for the srudents at Training Site. School's Manager of Experiential Learning, identified in Section 37 of this Agreement, will act
as the Liaison with Training Site. School will notify Training Site in writing of any change or proposed change of its Liaison. School
will be responsible for instruction and administration of the students' academic education program. School will have the final
responsibility for grading srudents.
8 . School's faculty will be available to discuss with Training Site's Practicum Site Supervisor at the beginning and end of the
practicum experience to discuss and evaluate the practicum experience .
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9. School will provide the names and information pertaining to relevant education and training for all students enrolled in the
practicum experience at least four weeks before the beginning date of the practicum experience. School is responsible for supplying any
additional information required by Training Site as set forth in this Agreement, prior to the arrival of students. School will notify
Training Site in writing of any change or proposed change in a student's status.
10. School will ensure evaluation of students' immune status with regard to current CDC standards for health-care personnel,
upon program entry and again each time standards are changed or updated. School will also ensure students receive initial and annual
tuberculosis screening according to current CDC guidelines.
11. School agrees to request a "Child and Adult Abuse Law" criminal background check (hereinafter CAAL check) through the
Washington State Patrol, pursuant to RCW 43.43.830-.842. Upon request, School agrees to provide Training Site with a copy of the
CAAL check results School receives from the Washington State Patrol pertaining to each student considered for placement at Training
Site. School acknowledges that placement of each student at the Training Site is contingent upon provision of CAAL check information
dated less than two years prior to the commencement of the practicum experience. Training Site acknowledges that School is not
responsible for the accuracy of the information provided through the CAAL check and that School does not certify the veracity of the
results provided. Training Site further acknowledges that School's provision of the CAAL check results does not relieve Training Site of
any of its legal obligations related to background checks.
12. School will direct students to comply with the policies and procedures established by Training Site.
13. School will encourage each student to acquire comprehensive health and accident insurance that will provide continuous
coverage of such student during his or her participation in the practicum experience. School will inform students that they are
responsible for their own health needs, health care costs, and health insurance coverage.
TRAINING SHE'S RESPONSIBILlTlES
14 . Training Site will supervise and provide students with a desirable practicum experience within the scope of health care services
provided by Training Site. Training Site will designate in writing one person as the Practicum Site Supervisor, who will maintain contact
with the School-designated Liaison to assure mutual participation in and review of the practicum experience and student progress.
15. Training Site will provide students with access to sources of information necessary for the practicum experience, within
Training Site's policies and procedures and commensurate with clients' rights, including library resources and reference materials.
16. Training Site will make available to students basic supplies and equipment necessary for practicum experience. Within the
limitation of facilities, Training Site will make available office and conference space for students and, if applicable, School faculty.
17. Training Site will submit required reports on each. student's performance and will provide an evaluation to School on forms
provided by School.
18. Training Site retains full responsibility for the care of clients, and will maintain the quality of client care without relying on the
students' practical activities for staffing purposes.
19. Training Site will have the right to take immediate temporary action to correct a situation where a student's actions endanger
client care. As soon as possible thereafter, Training Site's Practicum Site Supervisor will notify School of the action taken. All final
resolutions of the student's academic status in such situations will be made solely by School after reviewing the matter and considering
whatever written factual information Training Site provides for School; however, Training Site reserves the right to terminate the use of
its facilities by a particular student where necessary to maintain its operation free of disruption and to ensure quality of services.
20. Students will have the status of learners and will not replace Training Site personnel. Any service rendered by students is
incidental to the educational purpose of the practicum experience.
21. Students are required to adhere to the standards, policies, and regulations of Training Site during their practicum experience.
22. Students will wear appropriate attire and name tags, and will conform to the standards and practices established by School
during their practicum experience at Training Site.
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23 . Students assigned to Training Site will be and will remain students of School, and will in no sense be considered employees of
Training Site. Training Site does not and will not assume any liability under any law relating to Worker's Compensation on account of
any School student's performing, receiving training, or traveling pursuant to this Agreement. Except for when a specific agreement is
made between School or student and Training Site, students will not be entitled to any monetary or other remuneration for services
performed by them at Training Site, nor will Training Site otherwise have any monetary obligation to School or its students by virtue of
this Agreement.
LlABILl1Y COVERAGE PROVISIONS
24. Each party to this Agreement will be responsible for the negligent acts or omissions of its own employees, officers, students, and
agents in the performance of this Agreement. Neither party will be considered the agent of the other and neither party assumes any
responsibility to the other party for the consequences of any act or omission of any person, firm, or corporation not a party to this
Agreement.
25 . School will defend, indemnify and hold Training Site harmless from any loss, claim or damage arising from the negligent acts
and omissions of its employees, officers, agents, and students, including negligence connected with performing its obligations under this
Agreement, including the independent negligence of students. School maintains a professional liability coverage program under the
authority of RCW 28B .20.250, .253, and .255. Through that authority, School provides professional liability coverage for its employees,
officers , agents, and students (while participating in a practicum experience at Training Site) in the performance of this Agreement.
26. Training Site will defend, indemnify and hold School harmless from any loss, claim or damage arising from the negligent acts
and omissions of its employees, officers and agents, including the negligent supervision of students, and will maintain professional
liability coverage with limits of not less than $1,000,000 per occurrence and $3,000,000 annual aggregate (or an equivalent program of
self-insurance).
27. Both parties will provide proof of coverage upon execution of this Agreement. In addi tion, School and Training Site agree to
notify each other in the case of material modification or cancellation of coverage, and to provide subsequent proof of coverage
thereafter.
28. This Agreement is effective beginning March 1, 2017, and will continue thereafter from year to year. This Agreement will be
reviewed at the request of either party.
29. This Agreement may be terminated by written notice one year prior to termination; however, such termination shall not
become effective for the students then enrolled in the practicum experience if such termination prevents completion of their
requirements for completion of the practicum experience.
PROVISIONS REGARDING BLOOD-BORNE PATHOGENS
30. School has trained each student it will send to Training Site in universal precautions and transmission ofblood-bome
pathogens, and will send to Training Site only students who have practiced using universal precautions. Training Site will provide
personal protection equipment that is appropriate for the tasks assigned to School's students.
31 . In the event a student sustains a needle-stick injury or other substantial exposure to bodily fluids of another or other potentially
infectious material while participating in the practicum experience at Training Site, Training Site agrees to provide the following services:
• Provide or, at the option of the student, assist with seeking emergency medical care, at the student's expense;
• Provide HIV counseling and appropriate testing, at the student's expense; and
• Cooperate in the identification of and documentation for the source individual.
32 . The source patient's HBV, HCV and HIV status will be determined by Training Site in the usual manner to the extent possible.
MISCELLANEOUS PROVISIONS
Agreement between SPH and Kittitas County Health Dept.
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33. E.mir Agreement:. This Agreement constitutes the entire agreement between the parties, and supersedes all prior oral or
written agreements, commitments, or understandings concerning the matters provided for herein.
34. Amendmel1c. This Agreement may only be modified by a subsequent written agreement executed by the parties. The
provisions in this Agreement may not be modified by any attachment or letter agreement as described elsewhere in this Agreement.
35. Order of Precedence. Any conflict or inconsistency in this Agreement and its attachments will be resolved by giving the
documents precedence in the following order:
1. This Agreement;
2. Attachments to this Agreement in reverse chronological order.
36. Govqrning L-w,'. The parties' rights or obligations under this Agreement will be construed in accordance with, and any claim or
dispute relating thereto will be governed by, the laws of the State of Washington.
37. Notices. All notices, demands, requests, or other communications required to be given or sent by School or Training Site, will
be in writing and will be mailed by first-class mail, postage prepaid, or transmitted by hand delivery or facsimile, addressed as follows:
(a) To School:
Manager of Experiential Learning
University of Washington
SPH, Office of the Dean
Box 357230
Seattle, WA 98195·7230
Fax: (206) 685·9975
Email:·spl'losi@uw.oou
(b) 10 TrninifIC St ·tc:
Robin Read, Public Health Administrator
Kittitas County Public Health Department
507 N Nanum Street, Suite #102
Ellensburg, W A 98926
Fax: 509·962·7581
Email: robin.read@co.kittitas.wa.us
38. Each party may designate a change of address by notice in writing. All notices, demands, requests, or communications that are
not hand·delivered will be deemed received three (3) days after deposit in the U.S. mail, postage prepaid; or upon confirmation of
successful facsimile transmission.
39. Survival. School and Training Site expressly intend and agree that the liability coverage provisions of this Agreement will
survive the termination of this Agreement for any reason.
40. Sellcl'llhl Ii tv. If any provision of this Agreement, or of any other agreement, document or writing pursuant to or in connection
with this Agreement, shall be held to be wholly or partially invalid or unenforceable under applicable law, said provision will be
ineffective to that extent only, without in any way affecting the remaining parts or provisions of said agreement.
41. Waiver. Neither the waiver by any of the parties hereto of a breach of or a default under any of the provisions of this
Agreement, nor the failure of either of the parties, on one or more occasions, to enforce any of the provisions of this Agreement or to
exercise any right or privilege hereunder, will thereafter be construed as a waiver of any subsequent breach or default of a similar nature,
or as a waiver of any of such provisions, rights or privileges hereunder.
42. lnslj¢criol\. Training Site will permit, on reasonable notice and request, the inspection of its facilities by agencies charged with
responsibility for accreditation of School.
Agreement between SPH and Kittitas County Health Dept.
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Page 4
UNlVERSI1Y OF WASHINGTON SCHOOL OF PUBLIC
HEALTH
BY _~_&~_
David M. Anderson, DVM
Executive Director
Health Sciences Administration
<1f'
By -~:J!2;:L ~;t;i a-J -(7
Annette F1t~I)jlrri ck, PhD ~o1~
Assistant Dean for Graduate Education, UW School of Public Health
Agreement between SPH and KIttItas County Health Dept.
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KITTITAS COUN1Y HEALTH DEPARTMENT
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
Agenda Date 4/ J8/1~ 03/15/2017
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: School of Public Health University of Washington
Period Begin Date: March 1,2017 I I Period End Date: rvtt{)~~
Total Grant/Contract Amount: None
Grant/Contract Number:
Contract/Grant Summary:
I J J1)] b
The School of Public Health University of Washington allows the Kittitas County Public Health
Department to be a training site which is committed to training health care professionals, to provide
desirable practicum experiences and facilities for School's students.
Recommendation for Board of Health and Board of Health Review on
rl~-;-;" f\ ..if
Department Head Signature~, Administrator Date:--ti7
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROV D AS TO FORM: c:
Date
Signature of Board of Health member Date
Financial Information
Total Amount $ State Funds $ Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
In-Kind $
Explain
~
Grant/Contract Review Page 1
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring -reporting requirements
Futur~ impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes D attach budget form No D Why not
New Division Created?
Revenue Code
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I YesD No D
County Depa rtments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
i Signature:
Department:
I Date:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant a~plication
I Reviewer I Date
Grant/Contract Review Page 2