Application for Employment: {fullName} 

Date of Document Completion: {date62}

{fullName}
Date of Document Completion: {date62}

I, {fullName}, hereby ackbwledge my right to the following breaks:

*Where the nature of the work allows employees to take intermittent rest periods equivalent to ten minutes for each 4 hours worked, scheduled rest periods are not required. WAC 296-126-092

*Meal periods are considered hours of work when the employer requires employees to remain on duty on the premises or at a prescribed work site and requires the employee to act in the interest of the employer. As long as the employer pays the employees during a meal period in this circumstance and otherwise complies with the provisions of WAC 296-126-092, there is no violation of this law, and payment of an extra 30-minute meal break is not required.

{fullName}
Date of Document Completion: {date62}

Understanding how to prevent the transmission of bloodborne pathogens is essential in any caregiving environment. This training provides important information on how to protect yourself and others from exposure to potentially infectious materials such as blood and bodily fluids. Please review the Bloodborne Pathogens policy linked below carefully. Once you have read and understood the information, sign to acknowledge your completion of the training.

By signing, you confirm that you have received this information and understand that this serves as your personal copy of the policy.

Blood Borne Pathogens Policy

I, {fullName}, acknowledge that I have received and reviewed the information regarding Bloodborne Pathogens. I understand the importance of following safety protocols to prevent exposure to potentially infectious materials and agree to follow these guidelines while performing my duties. I also understand that this serves as my personal copy of the policy.

{fullName}
Date of Document Completion: {date62}

NWC Health Policy

{fullName}
Date of Document Completion: {date62}

As an employee of this organization, you are considered a mandated reporter under state law. This means you are legally required to report any suspected abuse, neglect, or exploitation of a vulnerable person, including children and adults with disabilities. If you have reasonable cause to believe that harm has occurred or is at risk of occurring, you must make a report to the appropriate authorities immediately.

Mandatory Reporting Resources
The following form includes important links to Washington State’s guidelines on mandatory reporting for both child abuse and the abuse of vulnerable adults. Employees of Northwest’s Child and Aaron’s Place are considered mandated reporters under state law.

Please read the materials carefully and save a copy for your own records, as this will serve as your personal reference and fulfill the requirement of receiving this information. 

Washington State Mandatory Reporting- Child

Resource for Adult Protective Services (ALTSA)

Click the link below to view the video "Making a CPS Referral."

Video Here

I understand that I am subject to the reporting requirements of Washington Administrative Code (WAC) 170-295-6040 (2) or School-Age WAC 170-297-6275 (1) (b), which states that I must immediately report an instance when I have reason to suspect that child physical, sexual, or emotional abuse, child neglect, or exploitation has occurred.  This report must be made to Children’s Administration Central Intake 866-END-HARM (866-363-4276).  If I believe there is immediate danger to a child I must also make a report to the local law enforcement. 

Acknowledgment

I acknowledge that I have received and reviewed the materials provided to me regarding mandated reporting, including written documentation and the required training video. I understand that as an employee, I am a mandated reporter and am legally obligated to report any suspected abuse, neglect, or exploitation of a child or vulnerable adult.

I understand the procedures for making a report and the importance of reporting immediately if I have reasonable cause to believe that harm has occurred or is likely to occur. I also understand that failure to fulfill this responsibility may result in legal and/or employment consequences.

By signing below, I confirm that I have completed the mandated reporter training, understand my obligations, and agree to comply with all related policies and procedures.

{fullName}
Date of Document Completion: {date62}

Confidentiality Agreement

The nature of services provided by Northwest Child requires information to be handled in a private, confidential manner. Northwest Child follows all ADSA & DSHS HIPAA laws and I understand that I, as an employee, must also follow these laws.
Information about our business or our employees or clients will only be released to people or agencies outside the company with our written consent. Following legal or regulatory guidelines provide the only exceptions to this policy. All reports, memoranda, notes, or other documents will remain part of the company’s confidential records.
The names, addresses, phone numbers or salaries of our employees will only be released to people authorized by the nature of their duties to receive such information and only with the consent of management or the employee.
The undersigned employee agrees to abide by this confidentiality agreement & follows any/all HIPAA regulations as stated by DSHS.