Confidentiality Agreement

As part of your work with the Salt Lake County Code Blue Site, you may have access to view, update or modify

sensitive information. You must treat this information as confidential and not share it with anyone unless

specifically authorized.

Sensitive Information is defined as:

● Client names, nicknames or any other identifying information

● Client addresses, locations or whereabouts (current or previous)

● Client health information including information on medical conditions, treatment or history

All information collected, accessed or viewed, as part of the Code Blue Site intake and operations is to be treated as confidential in written, electronic, printed and all other forms. Information is the shared property of Salt Lake County, Shelter the Homeless, and the Utah HMIS database and should not be released, shared or discussed without prior authorization. This includes communication in any form (e.g. oral, sign language, written) with clients,

co-workers, researchers, outside agencies or any other party.

In the event that you are unsure if information can be shared, DO NOT DISCLOSE THE INFORMATION, contact the Salt Lake County Code Blue Site Supervisor, Katie Zimmerman at katzimmerman@slco.org.

Unauthorized disclosure of information may result in disciplinary or legal action.

Volunteer Informed Consent, Assumption of Risk and Release of Liability Form

I, the undersigned, being at least eighteen (18) years of age, desire to participate as a volunteer in the Code Blue work relating to or sponsored in part by Salt Lake County. In consideration for being allowed to participate as a volunteer at a Salt Lake County Code Blue Site (“Code Blue”), I hereby enter into this Informed Consent, Assumption of Risk, and Release of Liability Agreement with Salt Lake County (“County”).

I understand the work to be performed and acknowledge the physical and mental demands that will be placed on me while providing volunteer services and hereby declare, to the best of my knowledge, I am able to perform the duties without endangering myself or others.

Accidents happen. I understand that Salt Lake County, its officers, employees, volunteers, contractors, agents, assigns, and sureties, collectively “Code Blue Leadership”, cannot eliminate all risks associated with its events and activities. I understand every activity has certain inherent risks of injury regardless of the precautions taken and that participation in Code Blue is strictly voluntary. I recognize that there are natural and man-made hazards, environmental conditions, diseases, and other risks which, in combination with my actions, may cause me injury. I hereby agree to assume all risks which may be associated with or may result from my participation in Code Blue, including but not limited to, transportation to and from volunteer sites. Injuries to participants may occur from risks inherent in the activity including emotional trauma; from placing stress on the body that it has not been prepared for; from the use of transportation, or from failing to follow training. The severity of injury can range from minor cuts, strains or discomfort to catastrophic injury such as paralysis or even death.

I recognize that if I am accepted to participate in Code Blue, I will be considered a volunteer of Salt Lake County and not an employee. I agree that all the work that I perform under this agreement will be non-compensable; except for preapproved compensation for actual expenses. I hereby agree to accept supervision as directed by the Code Blue Leadership and to perform my volunteer services to the best of my ability and in a professional manner.

As a volunteer, I understand that I may be considered a government employee under the Utah Volunteer Government Workers Act for the limited purposes of: (1) receiving workers’ compensation medical benefits; (2) the operation of a vehicle or equipment if I am properly licensed and authorized by County to operate said vehicle or equipment; and (3) liability protection and indemnification normally afforded paid government employees.

I understand that, if I am injured or involved in an accident while providing volunteer services for Code Blue, the County’s workers’ compensation will only pay for the actual and necessary medical expenses I incur in the treatment of an injury. Other expenses such as lost work time, equipment, clothing, etc. will not be covered. I understand that workers’ compensation medical benefits shall be my exclusive remedy for all injuries incurred while acting as a volunteer for the County and I hereby certify that I will be personally responsible for the cost of any emergency or other medical care that I receive which is not covered under said workers’ compensation medical benefits. In the event of an injury, I hereby expressly consent to any emergency medical aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is reasonable and necessary.

In consideration for my acceptance as a participant in Code Blue, and the services and amenities to be provided by the Code Blue Leadership, in connection with Code Blue, I confirm my understanding that:

● I have read any rules and conditions applicable to the Code Blue made available to me and I acknowledge my participation is at the discretion of the Code Blue Leadership.

● I have read and agree to abide by the anti-discrimination and sexual harassment information provided to me.

● The Code Blue officially begins and ends at the location(s) designated by the Code Blue Leadership. The Code Blue does not include carpooling, transportation, or transit to and from the Code Blue, and I am personally responsible for all risks associated with this travel.

● If I decide to leave early and not to complete the Code Blue as planned, I assume all risks inherent in my decision to leave and waive all liability against the Code Blue Leadership arising from that decision. Likewise, if the Code Blue Leadership has concluded the Code Blue, and I decide not to return to the end location designated by the Code Blue Leadership, I assume all risks inherent in my decision to go forward and waive all liability against the Cold Blue Leadership arising from that decision.

I authorize Cold Blue Leadership the right to take, publish, and make use of any and all pictures, video, or digital recordings taken of me to be used in and/or for promotional materials including but not limited to, newsletters, flyers, posters, brochures, annual reports, websites and social networking sites and other print and digital communications without payment or any other consideration. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. This authorization shall continue indefinitely.

I understand I may be subject to a criminal background check or other background checks.

Except as stated above, I hereby release and hold harmless Code Blue Leadership from any liability or obligation arising from or in connections with, my participation in Code Blue. I understand that this document is written to be as broad and inclusive as legally permitted by the State of Utah. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND UNDERSTAND THE CONTENTS OF THIS

AGREEMENT AND THAT I AM SIGNING THE SAME OF MY OWN FREE WILL. NO OTHER REPRESENTATIONS CONCERNING THE LEGAL EFFECT OF THIS DOCUMENT HAVE BEEN MADE TO ME.

I FURTHER ACKNOWLEDGE THAT THIS AGREEMENT SHALL BE BINDING ON MY HEIRS, REPRESENTATIVES AND ASSIGNS.