THIS AGREEMENT made in Duplicate as of the
day of
, 20
.
BETWEEN:
THE UNIVERSITY OF MANITOBA
Departments of Physical/Occupational Therapy
(hereinafter referred to as the "University")
-and-
(hereinafter referred to as the
"Clinical/Fieldwork Facility/Agency")
WHEREAS it is in the mutual interests of the University and the Clinical/Fieldwork Facility/Agency
that the development of Physical Therapy (P.T.) and Occupational Therapy (O.T.) be furthered through
the educational preparation of physical/occupational therapy students (hereinafter referred to as the
“students”) of the University by way of clinical/fieldwork experience at the Clinical/Fieldwork
Facility/Agency (hereinafter, the “clinical/fieldwork placement”).
NOW THEREFORE this Agreement witnesseth that in consideration of the mutual covenants herein
contained the parties hereto agree that:
1.
Term. This Agreement shall commence on
.
2.
Liaison. Liaison between the University and the Clinical/Fieldwork Facility/Agency shall be
by and through the following persons:
(a)
on behalf of the Clinical/Fieldwork Facility/Agency, the Clinical/Fieldwork
Facility/Agency Director or Designate,
(b)
on behalf of the University, the Academic Clinical/Fieldwork Co-ordinators, Physical
and Occupational Departments, College of Rehabilitation Sciences or designate,
(collectively referred to as the "Liaison").
The Liaison will meet in person or consult by telephone on a regular and planned basis.
3.
Responsibilities of Liaison.
The Liaison shall plan in advance of the expected
commencement dates of each academic year, preferably two (2) or three (3) months in advance,
for the clinical/fieldwork education program of the students at the Clinical/Fieldwork
Facility/Agency (the "Program").
The Liaison shall make any changes relating to the Program, which are required during the
course of each academic term.
4.
Responsibilities of University.
The University shall endeavour to present to the
Clinical/Fieldwork Facility/Agency as early as possible all necessary relevant information
including:
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
the number of P.T./O.T. students being placed in the program;
the respective education levels of the students;
the days and times of the student’s attendance;
the names and telephone numbers of academic staff members at the University who
will be involved with the Clinical/Fieldwork Facility/Agency;
the Physical/Occupational Therapy Department Clinical/Fieldwork Education Policies;
a summary of the relevant academic components of the curriculum;
the Physical/Occupational Therapy Department's expectations regarding the type of
clinical/fieldwork experience to be provided at the Clinical/Fieldwork Facility/Agency;
confirmation that the students have received training on the Personal Health
Information Act (PHIA);
completed Provincial Child Abuse Registry Check. The student will be responsible for
providing proof of a Provincial Child Abuse Registry Check prior to commencement of
the clinical placement; and
completed Criminal Record Check. The student will be responsible for providing proof
of a Criminal Record Check prior to commencement of the clinical placement.
5.
Orientation Period. The Clinical/Fieldwork Facility/Agency and the University will plan and
conduct a period of orientation to the clinical/ fieldwork placement for the students prior to the
beginning of the clinical/fieldwork placement. The parties contemplate that the orientation
information will include the presentation of selected current policies as well as such regulations
and procedures as the parties deem appropriate.
6.
Facilities. The Clinical/Fieldwork Facility/Agency will provide to the best of its ability for the
students, without charge to the University, such facilities at the Clinical/Fieldwork
Facility/Agency as are reasonable and appropriate including desks, telephones, lockers or
change rooms, access to a cafeteria and/or eating room, class and/or conference rooms, use of a
library and a parking space (to be provided free only if no parking charge is paid by other
persons).
7.
Clinical/Fieldwork
Facility/Agency
Facility/Agency shall be responsible for:
a)
b)
8.
Responsibilities.
The
Clinical/Fieldwork
clinical/fieldwork instruction and supervision of the student during each clinical
placement; and
completion of such evaluations and reports as required by the University.
Workers Compensation. As students under the Workers Compensation Act (Manitoba),
students engaged in practicums who are resident in Manitoba are covered for physical injuries
in accordance with and subject to the provisions of the Workers Compensation Act. In the
event of an injury during the practicum the Clinical/Fieldwork Site Supervisor should promptly
contact the University Liaison to ensure that coverage under the Workers Compensation Act is
secured.
9.
Indemnification. The University shall indemnify and save harmless the Clinical/Fieldwork
Facility/Agency and its officers, servants and agents from every action, suit or claim in respect
of any injury, loss or damage resulting from the grossly negligent acts or omissions by the
University, its officers or servants, when acting within the scope of their employment or by the
students when acting within the scope of the clinical/fieldwork placement, except to the extent
that injury, loss or damage is caused by the act or omission of the Clinical/Fieldwork
Facility/Agency, or any of its officers, servants or agents.
10.
Termination. This Agreement may be terminated any time by either party giving four (4)
months written notice to the other party, provided, however, any scheduled clinical/fieldwork
placement will not be terminated prior to completion (except where just cause exists in relation
to any individual student’s conduct during the corresponding clinical/fieldwork placement as
reasonably determined by the parties after mutual consultation).
11.
Amendments. The parties may amend any provision of this Agreement at any time upon
mutually so agreeing in writing.
12.
Risks. The Clinical/Fieldwork Facility/Agency shall, in keeping with its responsibilities to its’
clients and patients, have the right to intervene in those instances where a student may be
functioning in a manner considered by the Clinical/Fieldwork Facility/Agency to be of
potential risk to the well-being of the clients or patients, or, contrary to the Clinical/Fieldwork
Facility/Agency’s regulations, rules policies or procedures. In such event, and at the
Clinical/Fieldwork Facility/Agency’s request, the University and Clinical/Fieldwork
Facility/Agency shall mutually consult and determine whether a student will be withdrawn
from a placement if requested by the Clinical/Fieldwork Facility/Agency.
13.
Notice. 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 Clinical/Fieldwork Facility/Agency:
If to the University:
With respect to amendment or termination of this Agreement:
The University of Manitoba
The Dean’s Office, College of Rehabilitation Sciences
R106 – 771 McDermot Avenue
Winnipeg, Manitoba R3E 0T6
With respect to day-to-day administration of this Agreement:
Physical Therapy Department
Academic Co-ordinator of Clinical Education
College of Rehabilitation Sciences
R106 – 771 McDermot Avenue
Winnipeg, MB R3E 0T6
Occupational Therapy Department
Academic Fieldwork Co-ordinator
College of Rehabilitation Sciences
R106 – 771 McDermot Avenue
Winnipeg, MB R3E 0T6
14.
Counterparts. 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 on the day and year first
above written.
THE CLINICAL/FIELDWORK
FACILITY/AGENCY
THE UNIVERSITY OF MANITOBA
Per:
Per:
Administrator
(Print name beside signature)
Dean, College of Rehabilitation Services
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