SISOMB2009att5sssconf

SOCIAL & SCIENTIFIC SYSTEMS™
an employee-owned company

Survey and Epidemiology Services (SES Division)
ASSURANCE OF CONFIDENTIALITY FOR SES DIVISION EMPLOYEES
AND SUBCONTRACTORS
1.

I pledge to keep completely confidential the names of respondents, all information
or opinions reported by them and any information about them learned in the course
of working on a SES division project and to take every possible precaution to
prevent access to such information in my possession by anyone other than project
personnel.

2.

If as an office employee or field worker I encounter a respondent or information
about a respondent that is someone that I know personally, I shall immediately
terminate my involvement with the case and report the situation to my supervisor.
(For certain projects, specific exception to this rule will be granted in writing by the
SES division project director.)

3.

I understand that survey data containing personal identifiers must be kept either in
locked filing cases when not being used for home office processing activities or in a
locked room to which only project staff have access. (For each project, the SES
division project director will determine which procedure is to be used.)

4.

I understand that violation of the above, or of additional confidentiality procedures
required by the sponsor of a particular project, is sufficient grounds for disciplinary
action, including dismissal; and that violation of the privacy rights of individuals
through unauthorized discussion, disclosure, dissemination or access may
make me subject to criminal or civil penalties.
I hereby certify that I have read the four points above and will try to the
best of my ability to comply with each.

Signature: _____________________________________
Date: ________________________________________

8757 Georgia Avenue, 12th Floor

⋅ Silver Spring, Maryland 20910 ⋅ 301 628 3000 Fax 301 628 3001 ⋅ www.s-3.com