UTM and Placement Site | Protection of Confidential Information Agreement
I _____________________________ understand that by the virtue of my volunteer placement as an
academic intern from the University of Toronto Mississauga (UTM), I may have access to information or
records which contain individually identifiable information as well as other individuals' private
information or data and the disclosure of which is prohibited by the Freedom of Information and
Protection of Privacy Act of 1988 (FIPPA).
Security and confidentiality is a matter of concern for all academic interns from UTM and any other
persons who have access to information, data systems or physical facilities. Each person working at the
placement site holds a position of trust relative to this information. Therefore, as an intern within this
course, I agree to respect and adhere to the following statements:
1. I will not make or permit unauthorized use of any information.
2. I will exercise all reasonable care and caution in protecting printed or written confidential
information from casual observation, unauthorized perusal or other abuse.
3. I will not seek personal benefit or permit others to benefit personally by any confidential
information which has come to me by virtue of my work assignment.
4. I will not exhibit or divulge the contents of any record, data, or report to any person except in the
conduct of my work assignment.
5. I will not knowingly include or cause to be included in any record or report a false, inaccurate, or
misleading entry or to alter, destroy information, or commit any similar act. I will not view, remove,
or modify any data except as directed by my supervisor in the performance of my duties.
6. I will not aid, abet, or act in conspiracy with another to violate any part of this confidentiality
agreement.
7. I understand that client information that comes to my knowledge will be considered confidential
and will not be released to any other party.
8. I will immediately report any violation of this code to my supervisor.
When I cease my participation as an academic intern from UTM, I will return all related information and
property that I have in my possession, including without limitation documents, files, records, manuals,
information stored on a personal computer, personal data assistant or USB, supplies, and equipment or
office supplies, etc.
I acknowledge that I fully understand that the intentional disclosure by me of this information to any
unauthorized person could subject me to criminal and civil penalties imposed by law. I acknowledge that
I have been made aware of the confidential nature of information concerning activities, sensitive
information, clientele, business practices, children and their families (where relevant), etc. and the
confidentiality of such information will be respected. I further acknowledge that such willful or
unauthorized disclosure also violates the University of Toronto’s policies and could constitute just cause
for disciplinary action including removal from my internship duties immediately and without warning
regardless of whether criminal or civil penalties are imposed.
Required signatures located on page 2.
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UTM and Placement Site | Protection of Confidential Information Agreement
Required Signatures:
Intern Print Name:
Intern Signature:
Supervisor Name:
Supervisor Signature:
Date:
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