Independent Contractor-Worker Acknowledgement Form (PEDACKN).pdf

This is an Independent Contractor-Worker Acknowledgement Form (PEDACKN) related to the Ohio Department of Aging's Emergency Preparedness Course Development contract opportunity. The form serves as documentation for independent contractor status in relation to the proposed project. The contract opportunity itself involves the creation and facilitation of a 3-course curriculum on Emergency Preparedness designed for nursing home staff under the EXCEL Academy program. The vendor will be responsible for co-facilitating weekly live webinar modules alongside AGE staff and participating in weekly learning community sessions. The curriculum must incorporate didactic training, small group scenario-based training activities, and learning community discussion questions, with the Ohio Department of Aging providing the instructional design framework. The training program aims to equip nursing home personnel with competencies in emergency preparedness, response, and recovery across multiple emergency scenarios including natural disasters, fires, utility loss, hazardous chemical incidents, and state-level emergency declarations.

The acknowledgement form documentation establishes the contractual framework for independent contractor engagement on this project. Specific details regarding pricing terms, contract duration, renewal options, funding sources, and award dates are not detailed within this particular form document. The form functions as a formal recognition of independent contractor status and obligations related to the Emergency Preparedness Course Development initiative under Ohio's Quality Initiatives Division.