04 Attachment B - OVR Contractor Personnel Confidentiality Form.pdf
PDF 587 KB Posted
- Attached to
- Allegheny OVR Enhanced Driving/Anc Svcs
- Solicitation number
- 6100066394-1
- 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 use by contractor personnel providing non-emergency driving and ancillary services in Allegheny County. The form requires drivers and auxiliary personnel to acknowledge and agree to maintain strict confidentiality regarding all information concerning individuals applying for or receiving vocational rehabilitation services, as well as information related to OVR employees and customers. Personnel must pledge not to solicit, disclose, receive, or make use of any confidential information obtained during the execution of their duties, whether such information is written, verbal, or observed. The form is executed by both the driver and an OVR staff member, with signature and date fields provided for each party.
Breach of the confidentiality agreement outlined in this form may result in immediate termination of the associated contract. The form emphasizes the critical nature of information protection in the context of serving individuals with disabilities, including those who are blind, visually impaired, or otherwise unable to operate motor vehicles. This document serves as a contractual safeguard to ensure compliance with privacy obligations and protection of sensitive client and employee information under OVR's non-emergency transport services procurement (IFB 6100061271), which is reserved for small businesses certified under the Pennsylvania Department of General Services Small Business Contracting program.
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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 .