04 Attachment B - OVR Contractor Personnel Confidentiality Form.pdf
PDF 587 KB Posted
- Attached to
- Allegheny OVR Enhanced Driving/Anc Svcs
- Solicitation number
- 6100066394
- Issued by
- Allegheny County, Philadelphia City, Pennsylvania
About this file
This is a Confidentiality Form (OVR-142) issued by the Pennsylvania Department of Labor & Industry, Office of Vocational Rehabilitation (OVR), for contractor personnel engaged in providing non-emergency transportation services. The form serves as an agreement binding drivers and other contract personnel to strict confidentiality obligations regarding individuals applying for or receiving vocational rehabilitation services under the Allegheny County Enhanced Driving and Ancillary Services contract. The form requires signed acknowledgment that personnel will not solicit, disclose, receive, or make use of any information concerning vocational rehabilitation service recipients that is derived from the execution of their duties. The agreement extends to all information relating to OVR employees and customers, whether written, verbal, or observed, and applies to all matters conducted during the course of employment.
Breach of the confidentiality agreement may result in immediate contract termination. The form requires the driver to print their name, the associated contract number, driver signature, and date of execution, with countersignature by OVR staff. This confidentiality requirement is a mandatory compliance document for all personnel assigned to the contract, ensuring protection of sensitive information regarding individuals with disabilities who utilize OVR services for transportation to Commonwealth business locations. The form references Pennsylvania Numbered Memo 10-100.02 and affirms equal opportunity employment practices and availability of auxiliary aids and services for individuals with disabilities.
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Text version
OVR-142
7/10 ALL Department of Labor & Industry
Office of Vocational Rehabilitation
I, (Print name.)
agree that I will not solicit, disclose, receive or make use of any information concerning, persons applying for or receiving vocational rehabilitation services, directly or indirectly derived from the execution of my duties as a Driver pursuant to contract # .
I understand that I must not divulge this information to any person or entity. Breach of this confidentiality may result in termination of the contract.
Further, I agree to maintain the confidentiality of information obtained in the course of my duties with respect to all matters relating to employees and customers of the Pennsylvania Office of Vocational Rehabilitation, whether such information is written, verbal or observed.
Driver Signature Date
OVR Staff Signature Date
Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity Employer/Program
Refers to Numbered Memo 10-100.02
CONFIDENTIALITY
CONFIDENTIALITY
Sherrie Bruegman
OVR-142
7/10
ALL
Department of Labor & Industry Office of Vocational Rehabilitation I, (Print name.)
agree that I will not solicit, disclose, receive or make use of any information concerning, persons applying for or receiving vocational rehabilitation services, directly or indirectly derived from the execution of my duties as a Driver pursuant to contract # I understand that I must not divulge this information to any person or entity. Breach of this confidentiality may result in termination of the contract.
Further, I agree to maintain the confidentiality of information obtained in the course of my duties with respect to all matters relating to employees and customers of the Pennsylvania Office of Vocational Rehabilitation, whether such information is written, verbal or observed.
Driver Signature Date OVR Staff Signature Date Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity Employer/Program Refers to Numbered Memo 10-100.02
CONFIDENTIALITY
| Print or Type the driver's name.: |
| Type or Print the Contract number.: |
| Resets the form: |
| Prints the form.: |
File details come from the government source that posted it. Updated .