CONFIDENTIALITY STATEMENT

Confidential information or data is defined as “any information where the individual described is named or otherwise identifiable”. As a condition for my access to ROM provided by the Colorado Division of Child Welfare (“DCW”) I agree to uphold the confidentiality of the data in accordance with the following requirements:

I. I will avoid any action that will provide confidential information to unauthorized individuals or agencies.

II. I will not scan or review any DCW records or files to which I do not have specific authorization.

III. I will not make copies of any confidential DCW records, except as specifically authorized.

IV. I will not remove any confidential information from meetings.

V. All confidential data in my possession will be maintained in a safe manner which restricts unauthorized individuals from access.

VI. I will not discuss information that might lead to identification of individuals described in the DCW’s data files with any unauthorized person.

VII. I will limit my use of confidential DCW data to the purposes for which I have been specifically authorized.

VIII. I will not give my password(s) or file access codes to any unauthorized person, and upon termination will arrange for appropriate disposition of these codes and of all confidential data in my possession.

IX. If I become aware of any unauthorized access to, or divulgence of confidential DCW data by someone else, I will report it immediately to my supervisor or project coordinator, who will report it to DCW. I understand that failure to report violations of confidentiality by others is just as serious as my own violation and may subject me to legal prosecution.

I understand that if I fail to keep my agreement of confidentiality I will be denied access to the facilities and data of the DCW, and I may be subject to legal penalties. Any use, release, or publication of data contrary to the provisions stated may result in civil liability. I have read the above confidentiality requirements; it has been explained to me; and questions concerning it were answered prior to my signing.

Complete this form to acknowledge that you have read and accept the terms of this Colorado Results Oriented Management System Data User and Confidentiality Agreement and submit your request for access to ROM.