Form DHMH4518 "Combined Oit Policy Acknowledgment Form" - Maryland

What Is Form DHMH4518?

This is a legal form that was released by the Maryland Department of Health - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2010;
  • The latest edition provided by the Maryland Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DHMH4518 by clicking the link below or browse more documents and templates provided by the Maryland Department of Health.

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Download Form DHMH4518 "Combined Oit Policy Acknowledgment Form" - Maryland

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Maryland Department of Health and Mental Hygiene
Information Technology Security Policy,
Standards & Requirements
COMBINED OIT POLICY ACKNOWLEDGMENT FORM
This document is a combined policy acknowledgment form for DHMH computer-related policies. Following consultation
with your supervisor, please read and initial the appropriate acknowledgment sections, then sign the signature block
below.
Acknowledgement
Policy Number-Statement
Section- Initials
Employee
Supervisor
02.01.01 DHMH Information Technology Security Policy
Policy, Standards and Requirements for the protection of Information Technology. I hereby acknowledge
awareness of DHMH Policy 02.01.01, and that my use of these systems constitutes my consent to comply
with this directive.
02.01.02-Software Copyright Policy & the State of Maryland Software Code Of Ethics-
Unauthorized duplication of copyrighted computer software violates the law and is contrary to the State's
standards of conduct. The State disapproves of such copying and recognizes the following principles as
a basis for preventing its occurrence.
1. The State will not permit the making or using of unauthorized software copies under
any circumstances.
2. The State will provide legally acquired software to meet its legitimate software
needs in a timely fashion and in sufficient quantities to satisfy those needs.
3. The State will enforce internal controls to prevent the making or using of
unauthorized software copies, including measures to verify compliance with these
standards and appropriate disciplinary actions for violations of these standards.
I understand that making or using unauthorized software will subject me to appropriate disciplinary
action. I understand further that making copies of, or using unauthorized software may also subject me
to civil and criminal penalties. My signature below indicates that I have read and understand Policy
02.01.02- Software Copyright Policy and the State of Maryland Software Code of Ethics.
02.01.06-Policy to Assure Confidentiality, Integrity and Availability of DHMH Information (IAP)
I acknowledge that I am required to comply with the general applicable sections of this policy as it
relates to my current job duties. I further acknowledge that should I breach this policy, I am subject to
disciplinary, civil, and criminal consequences.
02.01.06-IAP–“Specific Personnel” Acknowledgement [ ] Check here if this applies.
If I am currently designated, or at any time my job duties require me to be designated as a
Custodian, Data Steward, Designated Responsible Party, Database Administrator, and/or Network
(System) Administrator, I acknowledge that I am required to comply with the corresponding
responsibilities assigned to specific personnel. Likewise, if I am currently required, or if at any time my
duties include the requirement for preparation or monitoring of contracts or memoranda of understanding,
I acknowledge that I am required to comply with the specific personnel provisions of the Information
Assurance Policy and guidance.
Employee/User Signature Block- I hereby acknowledge that I have reviewed and understand the above-initialed policies.
Employee/User Signature: ____________________________________ DATE: _______________
Employee/User
AGENCY/COUNTY:__________________
Identification
NAME:______________________________________________
ADMINISTRATION/UNIT:______________
(Please Print)
PIN # or CONTRACT#:______________________
_ LOCATION:__________________
Supervisor’s
Supervisor Signature___________________________________
°Supervisor verifies that the employee/user
Verification
DATE:_____________
has acknowledged and initialed the
appropriate policies for his/her position.
DHMH 4518 (REV Nov 2010) This form will be retained in the employee’s DHMH personnel file.
All pertinent policies can be accessed and read at
http://www.dhmh.maryland.gov/SitePages/op02.aspx
and State IT Security policy
http://doit.maryland.gov/Publications/DoITSecurityPolicy.pdf
Maryland Department of Health and Mental Hygiene
Information Technology Security Policy,
Standards & Requirements
COMBINED OIT POLICY ACKNOWLEDGMENT FORM
This document is a combined policy acknowledgment form for DHMH computer-related policies. Following consultation
with your supervisor, please read and initial the appropriate acknowledgment sections, then sign the signature block
below.
Acknowledgement
Policy Number-Statement
Section- Initials
Employee
Supervisor
02.01.01 DHMH Information Technology Security Policy
Policy, Standards and Requirements for the protection of Information Technology. I hereby acknowledge
awareness of DHMH Policy 02.01.01, and that my use of these systems constitutes my consent to comply
with this directive.
02.01.02-Software Copyright Policy & the State of Maryland Software Code Of Ethics-
Unauthorized duplication of copyrighted computer software violates the law and is contrary to the State's
standards of conduct. The State disapproves of such copying and recognizes the following principles as
a basis for preventing its occurrence.
1. The State will not permit the making or using of unauthorized software copies under
any circumstances.
2. The State will provide legally acquired software to meet its legitimate software
needs in a timely fashion and in sufficient quantities to satisfy those needs.
3. The State will enforce internal controls to prevent the making or using of
unauthorized software copies, including measures to verify compliance with these
standards and appropriate disciplinary actions for violations of these standards.
I understand that making or using unauthorized software will subject me to appropriate disciplinary
action. I understand further that making copies of, or using unauthorized software may also subject me
to civil and criminal penalties. My signature below indicates that I have read and understand Policy
02.01.02- Software Copyright Policy and the State of Maryland Software Code of Ethics.
02.01.06-Policy to Assure Confidentiality, Integrity and Availability of DHMH Information (IAP)
I acknowledge that I am required to comply with the general applicable sections of this policy as it
relates to my current job duties. I further acknowledge that should I breach this policy, I am subject to
disciplinary, civil, and criminal consequences.
02.01.06-IAP–“Specific Personnel” Acknowledgement [ ] Check here if this applies.
If I am currently designated, or at any time my job duties require me to be designated as a
Custodian, Data Steward, Designated Responsible Party, Database Administrator, and/or Network
(System) Administrator, I acknowledge that I am required to comply with the corresponding
responsibilities assigned to specific personnel. Likewise, if I am currently required, or if at any time my
duties include the requirement for preparation or monitoring of contracts or memoranda of understanding,
I acknowledge that I am required to comply with the specific personnel provisions of the Information
Assurance Policy and guidance.
Employee/User Signature Block- I hereby acknowledge that I have reviewed and understand the above-initialed policies.
Employee/User Signature: ____________________________________ DATE: _______________
Employee/User
AGENCY/COUNTY:__________________
Identification
NAME:______________________________________________
ADMINISTRATION/UNIT:______________
(Please Print)
PIN # or CONTRACT#:______________________
_ LOCATION:__________________
Supervisor’s
Supervisor Signature___________________________________
°Supervisor verifies that the employee/user
Verification
DATE:_____________
has acknowledged and initialed the
appropriate policies for his/her position.
DHMH 4518 (REV Nov 2010) This form will be retained in the employee’s DHMH personnel file.
All pertinent policies can be accessed and read at
http://www.dhmh.maryland.gov/SitePages/op02.aspx
and State IT Security policy
http://doit.maryland.gov/Publications/DoITSecurityPolicy.pdf