Job Shadow Attendance Agreement
AHS and APL supports opportunities for Job Shadow Participants to job shadow an AHS/APL host. As the healthcare environment may be unfamiliar, the Host and Manager must ensure that the Job Shadower is aware of and complies with the policies, directives and practices (together referred to as “rules”), such as confidentiality and safety.
Please read the following statements that are to be adhered to by all parties involved in the job shadow.
• I would like to participate in a Job Shadower at AHS/APL.
• I agree that it is my responsibility that the Job Shadower complies with all policies including confidentiality. The Host will explain to the Job Shadower that AHS/APL has a legal and ethical responsibility to safeguard the privacy of all patients/residents/clients and to protect the confidentiality of their personal information. My Job Shadower agrees to abide by the AHS/APL policies and procedures concerning confidentiality and release of information.
• I understand that all personal and health information the Job Shadower is privy to is private and confidential. The Job Shadower agrees not to discuss with anyone any individual’s identifying personal or health information that they may come into contact with while participating.
• I understand that I may be held responsible for any improper conduct of the Job Shadower, including but not limited to any breach of privacy or confidentiality.
• I agree that I will not hold AHS/APL liable or responsible for injury suffered to the Job Shadower while participating howsoever caused.
• I agree to indemnify AHS/APL for any loss that it may sustain as a result of the Job Shadowers participation.
• I understand that in order to participate in the program, the Job Shadower is required to have the Rubella vaccine (German Measles). It is also strongly recommended for the Job Shadower to have the following vaccinations and/or immunizations: Pertussis (Whooping Cough), Tetanus + Diphtheria, Measles, Mumps, Polio, Hepatitis B, Varicella (Chickenpox), Seasonal Influenza and Tuberculosis skin test.
The personal information on this form is collected under the legal authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. The information will be used by or disclosed for employment purposes. For questions, concerns or more information about the collection, use or disclosure of the personal information, please contact Information and Privacy at 1-877-476-9874 or by email at privacy@albertahealthservices.ca
By signing below, the Job Shadower states that he/she understands the detailed content of this Agreement and the Manager and Employee (Host) will reviewed it with him/her.