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HomeMy WebLinkAboutUWO/Oshkosh Health Dept-Clinical Education Program A- AGREEMENT BETWEEN THE BOARD OF REGENTS OF THE UNIVERSITY OF WISCONSIN SYSTEM ON BEHALF OF THE UNIVERSITY OF WISCONSIN OSHKOSH AND OSHKOSH HEALTH DEPARTMENT FOR THE CONDUCT OF A CLINICAL EDUCATION PROGRAM This agreement is between the Board of Regents of the University of Wisconsin System on behalf of the University of Wisconsin Oshkosh, College of Nursing (hereinafter referred to as "University ") and OSHKOSH HEALTH DEPARTMENT, Oshkosh, Wisconsin, (hereinafter referred to as "Facility "). In consideration of the mutual benefits to the respective parties, any and all departments of the University wishing to enter into a field placement with the Facility, and the Facility agree to the terms set forth below. THE UNIVERSITY AGREES: 1. That each school or college of the University wishing to participate in a clinical education or field placement program with the Facility will provide the Facility with a Program Memorandum, detailing the academic content of the proposed program. Upon acceptance of this Program Memorandum as provided hereafter, it shall become a part of this agreement and shall be incorporated by reference. The Program Memorandum will include discussion of program concepts; the controls which the University and the Facility may exercise or are required to exercise; the rights of the Facility to send representatives to review the University's program; the number of students to be assigned, the qualifications of those students and the schedule of those students; and /or any other matters pertaining to the specific program proposed by the department. 2. To recognize within the extent and limitations of Secs. 895.46(1) and 893.82, Wis. Stats., that the State will pay judgments for damages and costs against its officers, employees and agents arising out of their activities while within the scope of their assigned responsibility in the program at the Facility. 3. To provide the Facility with a listing of students who will be participating under the program and to update that listing periodically. THE FACILITY AGREES: 1. To review any Program Memorandum concerning a clinical education program, which is submitted by a school or college of the University. Upon review, the Facility will notify the school or college of its acceptance or rejection of the academic program proposal. 2. To satisfy the provisions contained in 45 CFR 46, existing for the protection of human subjects (to the extent that such regulations are applicable) to the respective program involved.. 3. Not to accept students as participants in the program unless the student is certified as a program participant in writing by the appropriate field work coordinator of a particular University school or college. THE UNIVERSITY AND THE FACILITY JOINTLY AGREE: 1. That there shall be no discrimination against students on the basis of the students' race, color, creed, religion, sex, national origin, disability, ancestry, age, sexual orientation, pregnancy, marital status or parental status. 2. That the State will indemnify University employees, officers, and agents (students in training required for a credit program and /or for graduation) against liability for damages arising out of their activity while acting within the scope of the respective employment or agency, pursuant to secs. 895.46(1) and 893.82, Stats. 3. That the Facility will indemnify its employees, officers and agents against liability for damages arising out of their activity while acting within the scope of their respective employment or agency, either by providing insurance or for political subdivisions of the State of Wisconsin pursuant to sec. 895.46, Stats. 4. By executing this agreement, neither the University nor the Facility waives any constitutional, statutory or common law defenses, nor shall the provisions of agreement create any rights in any third party. 5. This agreement shall be construed and governed by the laws of the State of Wisconsin. 6. See Affiliation Agreement Addendum attached for Caregiver Background Checks. TERM OF AGREEMENT: This agreement shall be for a term of three years, commencing June 1, 2008. Program Memoranda presented by the University and accepted by the Facility shall be for a term of no longer than three years. They may be renewed upon mutual agreement. Such Program Memoranda do not require the further approval of either party provided they contain provisions relating solely to program arrangements and content. All such Program Memoranda must be approved by the respective school or college within the University. Such Memoranda shall be effective for a period of three years. All fully executed Program Memoranda shall be incorporated by reference and become a part of this agreement if not inconsistent in any manner with this agreement. FOR THE BOARD OF REGENTS OF THE FOR THE FACILITY: UNIVERSITY OF WISCONSIN SYSTEM: OSHKOSH HEALTH DEPARTMENT I , CITY OF OSHKOSH • s l � ©t 5/21/08 Tom Sonnleitner, Vice Chancellor Date 1 / ature o Auth• . ,. 'Of is Date for Administrative Services ._. ` ,, • Fitzp. ckr, t ng City Manager -0 Of! ■fald Rosemary Smith, PhD, RN, APNP Name and Title (type or print) Date Dean and Professor Pamela R. Ubr i g, City Clerk College of Nursing AFFILIATION AGREEMENT ADDENDUM FOR CAREGIVER BACKGROUND CHECKS ON UNIVERSITY OF WISCONSIN STUDENTS University shall conduct a caregiver background check in accordance with the Caregiver Background Check statutes (Wis. Stats. §48.685 and §50.065) and regulations (Wis. Admin. Code Ch. HFS 12) for University students who have or are expected to have regular, direct contact with Facility's clients. University shall maintain completed Background Information Disclosure (BID) forms for those students, as well as the information that results from caregiver background checks. University will retain the BID form and caregiver background check results for inspection by the Department of Health and Family Services. University agrees to notify Facility of any information contained on a BID form and /or caregiver background check results about a student that could bar, as that phrase is defined by the relevant regulations, that student from regular, direct contact, as that phrase is defined by the relevant regulations, with Facility's clients. Facility shall make the final determination whether a student may have regular, direct contact with Facility's clients. Nevertheless, Facility shall consult with the appropriate University official before barring any such student from regular, direct contact with Facility's clients. If Facility determines a student may not have regular, direct contact with Facility's clients, University agrees not to permit that student to begin participation, or to continue participation that was properly allowed pending the results of the caregiver background check for up to 60 days, in the program created by this Agreement. University agrees to inform Facility of allegations of caregiver misconduct as defined in Wis. Admin. Code Ch. HFS 13 that come to University's attention. CERTIFICATE OF COVERAGE STATE OF WISCONSIN This is to certify that coverage described below is effective per the Statutory authority referenced. This certificate is not a policy or a binder of insurance and does not in any way alter, amend or extend the coverage afforded by any reference herein. The coverage is subject to all terms and conditions of the statutory authority. STATE AGENCY: CAMPUS NAME: Board of Regents of the UNIVERSITY OF WISCONSIN OSHKOSH University of Wisconsin System P.O. Box 8010 DATE ISSUED: Madison, WI 53708 May 15, 2008 KIND OF COVERAGE XX STATUTORY REFERENCES Workers' Compensation Liability XX S.895.46 and 893.82 Automobile Liability S895.46 Property Ch. 20.865 and 16.865 The entry of an XX in this column means that the coverage is afforded per this certificate and the statute references. ****************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** DATES OF COVERAGE: 6/1/2008 TO 5/31/2011 DESCRIPTION OF COVERAGE: LIABILITY COVERAGE FOR UNIVERSITY OFFICERS, EMPLOYEES AND AGENTS WHILE THEY ARE FUNCTIONING WITHIN THE SCOPE OF THEIR EMPLOYMENT OR AGENCY AT OSHKOSH HEALTH DEPARTMENT. ****************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ISSUED TO: PAUL SPIEGEL, HEALTH OFFICER SIGNED: 4 11,:,, OSHKOSH HEALTH DEPARTMENT JIM 61HN: +N 215 CHURCH AVENUE P.O. BOX 1130 DIRECTOR, RISK MANAGEMENT OSHKOSH, WI 54903 -1130