Instructions for Placement Agreement for Non-Clinical Practicum
Please insert the applicable information in designated areas as follows:
Date Line - 1st Tab:
Insert the day
Date Line - 2nd Tab:
Insert the month
Date Line - 3rd Tab:
Insert the year
Name of other party - 4th Tab:
Insert full legal name of the Placement Site
Preamble - 1st Tab:
Identify discipline (i.e. Pharmacy, Social Work)
Section 1 - 1st Tab:
Insert month and day when the Agreement will begin
Section 1 - 2nd Tab:
Insert year when the Agreement will begin
Section 1 - 3rd Tab:
Insert month and day when the Agreement will end
Section 1 - 4th Tab:
Insert year when the Agreement will end
Section 2 (a):
Insert the position of the liaison for the Placement Site
Section 2 (b):
Insert the position of the liaison for the University
Section 17 1st Tab:
Insert the name of the Placement Site
2nd Tab:
Insert the street address of the Placement Site
3rd Tab:
Insert the City, Province and Postal Code (in that order) of the
Placement Site
4th Tab:
Insert the name of the Department within the University (ie. Faculty
of Pharmacy)
5th Tab:
Insert the building/ address for the Department within the University
6th Tab:
Insert the City, Province and Postal Code (in that order) for the
Department within the University
Signature Line – 1st Tab:
Insert the position of University signing authority (ie. Dean, Faculty
of Pharmacy)
Signature Line - 1st Tab:
Insert the full legal name of the Placement Site
Signature Line - 2nd Tab:
Insert position of signing authority for the Placement Site
Signature Line - 3rd Tab:
Insert position of signing authority for the Placement Site, if
applicable
2
Routing –please also see: http://umanitoba.ca/admin/vp_admin/legal/media/signing_policy.pdf
1.
forward the completed Agreement to the appropriate Dean or Director for signature, ensuring
that a sufficient number of copies of the Agreement are signed so that each party who will be
signing the Agreement may keep an original copy.
2.
arrange for the other party(ies) to sign the Agreement.
3.
Once all signatures are obtained, provide one original copy to each party. The University’s
copy must be forwarded to the Office of Legal Counsel for filing in the University’s central
contracts vault. A photocopy of the Agreement should be kept for your records.
THIS AGREEMENT made in duplicate as of the
day of
, 20
.
BETWEEN:
THE UNIVERSITY OF MANITOBA
(the “University”)
- and (the “Placement Site”)
WHEREAS it is in the interests of the University and the Placement Site that the development of
in
Manitoba be furthered through the educational preparation of the students of the University by way of a
practicum experience at the Placement Site (the “Practicum”).
NOW THEREFORE this Agreement witnesseth that in consideration of the mutual covenants herein contained
the parties hereto agree that:
1.
This Agreement shall commence on
, 20
and end on
, 20
, with automatic
renewals thereafter for one (1) year subsequent terms, except if written notice of termination is given
by one party to the other six (6) months prior to the commencement of the new term.
2.
Liaison between the University and the Placement Site shall be by and through the following persons:
(a)
on behalf of the Placement Site, the
may delegate from time to time; and,
(b)
on behalf of the University, the
delegate from time to time;
, or such other individual as the Placement Site
, or such other individual as the University may
(collectively referred to as the “Liaison”). The Liaison will consult by telephone on a regular and
planned basis.
3.
The University shall notify the Placement Site that the University has approved a Practicum proposal
developed by a University student in consultation with an academic advisor and the Placement Site.
Changes may not be made to any University approved Practicum without the University’s prior
approval.
4.
The Placement Site will plan and conduct a period of orientation to the Placement Site for the students
prior to the commencement of each Practicum. It is contemplated that the orientation period will
include the presentation of selected current policies, regulations and procedures of the Placement Site.
5.
The University acknowledges the importance of confidentiality of personal health information in
accordance with The Personal Health Information Act (Manitoba) (the “Act”) and patient privacy
laws. In compliance with its obligations under the Act, the Placement Site will, as part of its
orientation program, distribute and explain to the students, a confidentiality pledge in such form and
content as may be appropriate, in accordance with the Act. The Placement Site shall maintain the
confidentiality pledges within its record as evidence of its compliance with the Act.
-2The University shall not be liable in any manner for a failure or omission by the Placement Site to
comply with its obligations under the Act in connection with the form, content or execution of the
confidentiality pledges, or any other related or other matter under the Act.
6.
The Placement Site will provide for the undergraduate students of the University, without charge to
the University, such facilities at the Placement Site as are reasonable and appropriate, such as lockers
or change rooms, access to cafeteria and/or eating room, class and/or conference rooms, use of a
library and parking space (to be provided free only if no parking charge is made to other persons).
7.
The Placement Site shall be responsible for:
8.
(a)
instruction and supervision of student(s) during each Practicum;
(b)
such evaluation and reports as required by the University.
As students under The Workers Compensation Act (Manitoba) (the “Workers Compensation Act”)
students engaged in the Practicum are covered for injuries in accordance with and subject to the
provisions of the Workers Compensation Act. In the event of an injury during the Practicum, the
Placement Site Liaison should promptly contact the University Liaison to ensure that a report and
claim can be made to the Workers Compensation Board.
Where the location of the Placement Site is outside of the Province of Manitoba, and students engaged
in the Practicum are not resident in Manitoba, the University makes no representation as to workers
compensation coverage in place.
9.
The University shall indemnify and save harmless the Placement Site and its officers, servants and
agents from every action, suit or claim in respect of any injury, loss or damage resulting from the
negligent acts or omissions by the University, its officers or servants, when acting within the scope of
their employment or by the undergraduate students when acting within the scope of the Practicum,
except to the extent that injury, loss or damage is caused by the act or omission of the Placement Site,
or any of its officers, servants or agents.
10.
The Placement Site shall indemnify and save harmless the University and its officers, servants and
agents from every action, suit or claim in respect of any injury, loss or damage resulting from the
negligent acts or omissions by the Placement Site, its officers or servants, when acting within the
scope of their employment, except to the extent that injury, loss or damage is caused by the act or
omission of the University, or any of its officers, servants or agents, or by students acting within the
scope of the Practicum.
11.
This Agreement may be terminated any time by either party giving four (4) clear months written notice
to the other party, provided, however, that any scheduled Practicum will not be terminated prior to
completion by the student(s) of the said Practicum (except where just cause exists in relation to any
individual student’s conduct during the corresponding Practicum).
12.
The parties may amend any provision of this Agreement at any time upon mutually so agreeing in
writing.
13.
The Placement Site shall, in keeping with its responsibilities to its clients, have the right to intervene
in those instances where a student may be functioning in a manner considered to be of potential risk to
the well-being of the client or contrary to the regulations, rules, policies or procedures of the
Placement Site. In such event, the University shall withdraw a student from a Practicum if requested
by the Placement Site.
-314.
The Placement Site shall not, without obtaining the prior written consent of the University, assign or
transfer this Agreement or any interest herein.
15.
Sections 5 (if applicable), 9 and 10 shall survive termination of this Agreement.
16.
This Agreement shall be construed in accordance with the laws of Manitoba as applied to
transactions taking place entirely within Manitoba between Manitoba residents.
17.
All notices to be given by either party to the other under this Agreement shall be delivered or mailed
by registered or certified post, postage prepaid, addressed to such other party respectively as follows:
If to the Placement Site:
If to the University:
18.
This Agreement may be executed in any number of counterparts and by different parties in
separate counterparts, each of which when so executed shall be deemed to be an original and
all of which taken together shall constitute one and the same agreement. Delivery by
facsimile or by electronic transmission in portable document format (PDF) of an executed
counterpart of this Agreement is as effective as delivery of an originally executed counterpart
of this Agreement.
IN WITNESS WHEREOF the parties have hereto executed this Agreement as of the day and year first above
written.
THE UNIVERSITY OF MANITOBA
Per:
Title:
Per:
Title:
Per:
Title:
F:\LEGAL OFFICE\Precedents\Website Documents\Signing Policy\Field Placement Site Agreement (Non-Clinical) March 2010.doc