Attachment 7: Contractor Confidentiality Agreement

Attachment 07_Contractor_Confidentialiy_Agreement.dot

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture

Attachment 7: Contractor Confidentiality Agreement

OMB: 0925-0406

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WESTAT PROTECTION OF HUMAN SUBJECTS TRAINING

CERTIFICATION OF COMPLETION

Please fill out form electronically





Employee’s Information


Employee’s Name:              

LAST FIRST MI


Westat ID Number:       Study Area Organization Number:      


I have completed Westat’s instruction on the Protection of Human Subjects. The version was:


Systems and Data Management Staff


Project Staff






Signature: Date Completed:      

MM/DD/YYYY





For Computer Systems Staff (except those in the Clinical Trials Area):

E-mail the form as an attachment, or send a signed hard-copy of this form to
Cecilia Wilson at WB316S. If the form is sent as an e-mail document, a signature is not required.


For All Other Staff:

E-mail the form as an attachment, or send a signed hard-copy of this form to Carol Dollarhide at WB315. If the form is sent as an e-mail document, a signature is not required.

Revised: 07/06/2007


File Typeapplication/msword
File TitleATTACHMENT G
Authorvarela_j
Last Modified ByCecilia Wilson
File Modified2007-07-06
File Created2006-02-07

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