Sample Confidentiality Agreement Template printable pdf download

Sample Confidentiality Agreement Template

Individual Council logo

to be added here

CONFIDENTIALITY AGREEMENT

Name of Local Council_____________

City_____________________________

Print Name

________________________________

The protection of confidential information both past and present is vital and necessary to

the interests and success of the Name of Council. Confidential information includes, but

is not limited to the following examples:

Client names and personal information

Whether or not the client is receiving services

All client file information

All personal staff or volunteer personal information

Donor names or information

Financial information

Computer programs, codes and data

Other information and data communicated as confidential

Also, it is expected that volunteers will not initiate any council related communications

with those served by the local council or their family members when encountered in

public places nor acknowledge your familiarity with them.

This organization’s confidentiality policy is compatible with and in accordance with all

federal and state related statutes and other professional ethics and standards. If you are

uncertain about whether information is confidential, check with your volunteer

coordinator before discussing it with anyone. All volunteers are required to adhere to

this policy.

Improper use or disclosure of confidential information may result in

disciplinary action, up to and including termination of volunteer status and//or

appropriate legal action.

I acknowledge the Council's policy regarding confidentiality and agree to abide by and

understand the consequences of improper use or disclosure of confidential information.

_______________

______________________________

Date

Volunteer Signature

_______________

______________________________

Date

Personnel Signature

CTF and/or other logos placed across bottom of sheet

Sample Confidentiality Agreement Template