CONFIDENTIALITY PLEDGE <Organization and/or Project Name> All persons having access to THE DATA SET must agree with and affix their signature to the following: hereby swear or affirm to comply with the following policies to protect the confidentiality of the data contained within “I THE DATA SET”: To obtain approval from <relevant individuals and/or review boards> prior to conducting any linkage or research activity utilizing THE DATA SET; Not to use nor permit others to use THEH DATA SET data in any way other than for approved record linkages and statistical reporting and analysis for research or surveillance purposes; To release no data or information that is identifying or which can lead to the identification of an individual; To not attempt to contact individuals or family members of individuals whose information is contained in THE DATA SET; To only report data derived from record linkages and/or THE DATA SET in aggregate, and not to report any statistics generated from case counts of less than 5; To use appropriate safeguards to protect the confidentiality of the information contained within THE DATA SET, including password protection of desktop and laptop computers, file encryption, leaving the project laptop computer unattended while traveling; To immediately report to <relevant individuals and/or review boards> any unapproved use or disclosure of data or information. I will assure that all persons with approved access to THE DATA SET will sign appropriate confidentiality pledges.” Name and organization Signature ________________________________________ Date_________________
CONFIDENTIALITY PLEDGE <Organization and/or Project Name> All persons having access to THE DATA SET must agree with and affix their signature to the following: “I hereby swear or affirm to comply with the following policies to protect the confidentiality of the data contained within THE DATA SET”: To obtain approval from <relevant individuals and/or review boards> prior to conducting any linkage or research activity utilizing THE DATA SET; Not to use nor permit others to use THEH DATA SET data in any way other than for approved record linkages and statistical reporting and analysis for research or surveillance purposes; To release no data or information that is identifying or which can lead to the identification of an individual; To not attempt to contact individuals or family members of individuals whose information is contained in THE DATA SET; To only report data derived from record linkages and/or THE DATA SET in aggregate, and not to report any statistics generated from case counts of less than 5; To use appropriate safeguards to protect the confidentiality of the information contained within THE DATA SET, including password protection of desktop and laptop computers, file encryption, leaving the project laptop computer unattended while traveling; To immediately report to <relevant individuals and/or review boards> any unapproved use or disclosure of data or information. I will assure that all persons with approved access to THE DATA SET will sign appropriate confidentiality pledges.” Name and organization Signature ________________________________________ Date_________________
Sample%20conf%20pledge.docx