SISOMB2012att4StaffConf

SISOMB2012 ATTACHMENT 4: STAFF CONFIDENTIALITY

CONFIDENTIALITY POLICY
All employees of Public Health Research Group (PHR) of Social & Scientific Systems,
Inc., (SSS) are required to sign this Assurance of Confidentiality. Temporary employees
with access to research materials are also required to sign this form.

ASSURANCE OF CONFIDENTIALITY FOR SSS PHR GROUP EMPLOYEES

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 SSS 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 SSS project director.)

3. I understand that survey data containing personal identifiers must be kept a) in locked filing
cases when not being used for home office processing activities or b) in a locked room to
which only project staff have access. (For each 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.

Name (print): _______________________________________________
Signature: _________________________________________________
Date: _____________________________________________________

(form version date: January 2010)