HomeMy Public PortalAbout152-2019 - Fire - Affiliation Agreement...ch - Student Affiliation Agreementse
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IVY TECH COMMUNITY COLLEGE OF INDIA.NA-Richmond
AGREEMENT OF AFFILIATION
SCHOOL OF HEALTH SCIENCES AND SCHOOL OF NURSING
AND
Richmond Fire Department
This Agreement, made and entered into this 28th day of August, 2019 to be in effect for
two years, between Ivy Tech Community College of Indiana Richmond, (hereinafter referred to
as the College) and Richmond Fire Department, located in Richmond, Indiana (hereinafter
referred to as the Facility). Prior to the date of termination, the agreement shall be automatically
renewed for additional periods unless either party requests a change or termination of the
agreement. '
WITNE S S THAT
WHEREAS, the College is required to provide clinical experience for educational
purposes to its students;
WHEREAS, "clinical" refers to any type of course in which the student may have patient
contact as a part of the course, regardless of actual course title or location of the patient
interaction. This includes situations in which students have contact with patients or patients'
health records in an observational role, even if not providing direct patient care or patient care
services. Other examples of relative course titles include internship, externship, clinical
practicum, co-op;
WHEREAS, the Facility is willing to make available its facilities to said College and its
above described students for said educational experience, which will necessarily include the
performance of tasks by the students.
NOW THEREFORE, it is agreed:
I. The College shall provide the following:
A. Responsibility, in coordination with the Facility, for the assignment of students
and the planning and administration of the educational program(s). Students
assigned should only be those who meet the criteria for eligibility as established
by the College and approved by the Facility, and no student shall be assigned to
Facility without prior consent of the College.
B. Texts and materials that will be purchased by the students.
C. Other services available to all students of the College as appropriate.
D. Required documentation of immunity to communicable/infectious diseases,
screening for tuberculosis, and verification by licensed physician, physician
Contract No. 152--2019
Revised 7-26-18 Page 1 of 7
assistant, or advanced registered nurse practitioner of students' ability to meet
program specific essential functions. The Facility may request copies of these
documents to review.
E. A schedule of students assigned to the Facility and the clinical objectives for the
students will be sent to the Facility in advance of each clinical rotation.
F. Names and qualifications of program faculty who may be assisting with clinical
instruction or evaluation during site visits. Copies of licensure, if applicable, will
be kept in the files of the College.
G. The students with training in compliance with Occupational Safety and Health
Administration (OSHA) on universal precautions and Blood -borne pathogen
regulations, fire and electrical safety, client confidentiality, and tuberculosis
transmission, including any required content provided by the Facility. Proof of
participation in instruction on these subjects by the students will be provided to
the Facility upon request.
H. Documentation of students current CPR certification, Course C (American Heart
Association) or health care provider level (American Red Cross), or equivalent.
I. Notification to the Facility immediately of any change in the status of
accreditation or state regulatory approval status.
II. The Facility shall provide the following:
A. Classroom and/or conference room space as may be necessary to carry out the
clinical instruction for students at the Facility.
B. Sufficient number of staff to carry out normal service functions, so students will
not be performing functions in lieu of staff.
C. A reasonable amount of secure storage space for apparel and personal effects of
participating students.
D. Access to library facilities (if available) for students while assigned to the
Facility.
E. Emergency care to students, at the students' expense, for work -related illnesses
and accidents, occurring ,while the student is in traini g at the Facility.
F. Personal protective equipment availability and use as required by the OSHA
Bloodborne Pathogen Standard and other applicable OSHA acts.
G. written copies of the Facility's policies and procedures that apply to the College
faculty and students.
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H. Reasonable efforts to make available clinical experiences and access to
information at the Facility as necessary to meet the objectives of the course.
I. Retain responsibility for the care of patients in the Facility.
J. Provide notification to the College immediately of any change in the status of
certification, licensure and/or accreditation, or any other matter that might be
relevant to the status of the Facility.
III. The College and the Facility mutually agree that:
A. The College has the sole responsibility for the selection of students for the
program. The Facility will provide the College with information regarding the
number of students that can be accommodated for each clinical rotation. The
College will provide the Facility the schedule of students assigned to the Facility,
and a list of student objectives for the rotation.
B. Students absent from clinical instruction for any reason may be required to make
up that lost time at the discretion of the Facility and the College.
C. Students are not to be paid by the Facility for clinical instruction time.
D. Students shall wear the official uniform of their program or designated attire
while on duty in the Facility.
E. The College reserves the right to withdraw from the program any student whose
work or conduct may reflect discredit to the program and the profession, and
whose progress is not satisfactory to the College.
F. The Facility reserves the right to withdraw from its premises, upon request and
demonstration of reasonable cause by Facility, any student. The Facility reserves
the right to immediately remove any student whose presence at Facility, as
determined by Facility, may compromise patient care. In the event that a student
is removed from the clinical education experience the individual shall promptly
vacate Facility premises, remove any and all personal property and return any
Facility proprietary information to the Facility.
G. The Facility may request a faculty member from the College be removed from
teaching responsibilities in the facility upon providing in writing due cause for
such action.
H. The College and the Facility are equal opportunity/affirmative action institutions
and will make educational decisions in a manner that will not discriminate against
individuals on the basis of sex, race, color, creed, national origin, age, mental or
physical handicaps, or veteran status; provided, however, that with respect to
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physical handicaps, the handicap must not be such as would, even with reasonable
accommodation, in and of itself, preclude the student's effective participation in
the program.
I. As required by program accreditation agencies, the students may be given a
synopsis of this affiliation agreement that outlines their responsibilities.
J. The students will not be considered agents or employees of the Facility for any
propose.
K. In cases where facility staff are directly supervising students, the College will
provide orientation to the course objectives and policies. General supervision of
the course is the responsibility of the College faculty.
L. The students may be required by the Facility to sign a patient confidentiality
statement.
M. Each party agrees that it will comply in all material respects with all federal and
state laws, regulations, rules or orders applicable to privacy, security and
electronic transactions, including but not limited to, regulations promulgated
under Title II, Subtitle F of the Health Insurance Portability and Accountability
Act (HIPAA).
N. The students will have a drug test prior to the first semester of clinical experience.
A repeated drug test will be completed by students who are enrolled in clinical
courses for more than 12 months. The drug testing will include testing for the
following substances:
■ Marijuana (cannabis, weed, hemp)
■ Cocaine (coke, snow, blow)
■ Opiates (morphine, codeine)
■ Amphetamines and methamphetamines (Ritalin, Ecstasy, speed, meth)
■ Phencyclidine (PCP, angel dust)
■ Propoxyphene (Darvon)
■ Barbiturates (Valium, Librium)
■ Methadone (oxycodone, hydrocodone, Vicodin)
■ Benzodiazepines (Versed, Dalmane, Restoril, Xanax)
■ Methaqualone (Quaalude, Sopor)
a. The students will have a criminal background check prior to the first semester of
clinical experience. An updated criminal background check will be completed for
students enrolled in clinical courses for more than 12 months. .
The criminal background check will include:
■ County, state, and federal criminal record searches of all places of
principal residences for the past 7 years (or since age 18, if Less than 25
Revised 7-26-18 Page 4 of 7
years old). Records will be verified against all known names and
addresses as revealed on the social security report.
■ National criminal history database that includes 50-state sex offender and
Office of Foreign Assets Control (0FAQ List of Specially Designated
Nationals (SDN).
■ Office of Inspector General (OIG)1 General Services Administration
(GSA) Sanction Reports, United States Treasury, applicable state
exclusion list
■ Social security verification and residency report
■ Maiden name and alias report
P. The students will provide the Facility with direct access to the internet based drug
screen and criminal background results via a password protected portal at least
two weeks prior to the Student's arrival at the Facility for clinical experiences.
Alternatively, the Facility may ask the student to submit a printed copy of the
drug screen and criminal background results.
Iv. Indemnification
A. The College agrees to indemnify and hold harmless the Facility against all claims,
actions, causes of action and/or judgments and for all costs and expenses incurred
by the Facility (including attorneys' fees) arising from or out of any personal
injury or property damage to the extent that the same results from the negligent
acts or omissions of the College, it servants, agents and students while performing
any service during the term of the Agreement of the premises of the Facility. The
Facility agrees to give to the College notice in writing within thirty (30) days after
receiving any of these claims or after it has knowledge of any other damage, loss
or expense incurred by them resulting from the above negligent acts or omissions.
V. Insurance
A. During the duration of this Agreement, the College agrees to maintain in force at
its expense worker's Compensation and Employer's Liability Insurance to cover
employees at limits in accordance with Indiana laver, Commercial General
Liability insuring the students, the College, its instructors, affiliate instructors, and
the Facility, providing coverage against liability for any injury, damage, loss or
expense arising out of or pertaining in any fashion whatsoever to the services or
obligations here under, including by not limited to claims brought by or on behalf
of a student for personal injury or property damage. The limits of such insurance
will be in the amount of $1,000,000 per claim and $2,000,000 per year, with
limits of at least $500,000 for property damage.
B. The College shall maintain limits consistent with being a qualified provider under
Indiana's Medical Malpractice Act, IC 34-1 S (the Act), for the institution, its
students, and faculty where eligible. If students or faculty do not qualify for
coverage under the Act, the College shall maintain Professional Liability
Revised 7-26-18 Page 5 of 7
Insurance that covers the students, faculty, and the College with limits in the
amount of $1,000,000 per claim and $3,000,000 aggregate. Since the Facility
shall be named as an Additional Insured on all such insurance, the provider or
providers of such insurance shall be obligated to give a thirty (30) day notice to
the Facility of any cancellation, non --renewal or material change in the policy or
policies. The College shall furnish the Facility certificates of insurance or such
other evidence of the existence of said insurance as is satisfactory to the Facility.
VI. Modification and Termination
A. Modification of this agreement will be made only by mutual written consent of
the parties.
B. This agreement shall be effective when executed by both parties for a period of
two years and will be automatically renewed annually unless otherwise terminated
or modified in accordance with, the agreement.
C. This agreement may be terminated by either party by giving to the other ninety
(90) days notice in writing, providing, however that any students currently
enrolled shall be given an opportunity to complete this program as offered when
they registered.
VII. Copies of the Agreement
Copies of this agreement shall be retained by or made available to the following:
1. Administrator of the Facility or designee
2. Chancellor of the College
3. Dean for the School of Health Sciences
4. Dean for the School of Nursing
VIII. This Agreement contains the entire understanding of the parties with respect to the
matters contained herein. There are no other promises, covenants, or undertakings other
than those expressly set forth herein.
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Witness, the parties hereto agree as to the 2 Sth day of August, 2019.
For the College:
r
r. Stacy Atkinson 'Date.
Chancellor (Acting)
Ivy Tech Community College Richmond
Dr. Stacy Atkinson Date
Vice Chancellor for Academic Affairs
Ivy Tech Community College Richmond
411 Anderson D to
\J,Jean for the Schools of Health Sciences,
Arts, Sciences, and Education
Ivy Tech Community College Richmond
1012411
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Heat er ierrehool
ski-Cross Date
Dean for the of Nursing
Ivy Tech Community College Richmond
For the Facility:
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en Simmons Date
RFD EMS Chief
Richmond Fire Department
Richmond, IN
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Vicki Robinson, President Date
Board of Public Works and Safety
Emily Palm r, Member Date
Board of Public Works and Safety
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Matt Evans, Member Date
Board of Public Works and Safety
M. Snow Mayor Dat
City of Richm nd, Indiana
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