Sample Employee Confidentiality Agreement/Oath Template
Unit 7: Confidentiality and Data Security
Annex 7.3. Sample Employee Confidentiality Agreement/Oath
<Insert Name of Agency Here>
As an HIV/AIDS Programme employee, subcontracted employee, student, or visiting
professional, I understand that I will be exposed to some very privileged patient information.
Examples of such information are medical conditions, medical treatments, finances, living
arrangements, and sexual orientation. The patient's right to privacy is not only a policy of the
HIV/AIDS Programme, but is specifically guaranteed by statute and by various governmental
I understand that intentional or involuntary violation of the confidentiality policies is subject to
appropriate disciplinary action(s), which could include being discharged from my position and/or
being subject to other penalties. By initialling the following statements I further agree that:
_____ I will never discuss patient information with any person outside of the programme who is
not directly affiliated with the patient's care.
_____ If in the course of my work I encounter facilities or programmes without strict confidentiality
protocols, I will encourage the development of appropriate confidentiality policies and procedures.
_____ I will handle confidential data as discretely as possible and I will never leave confidential
information in view of others unrelated to the specific activity. I will keep all confidential
information in a locked cabinet when not in use. I will encrypt all computer files with personal
identifiers when not in use.
_____ I will shred any document to be disposed of that contains personal identifiers. Electronic
files will be permanently deleted, in accordance with current HAP required procedures, when no
_____ I will maintain my computer protected by power on and screen saver passwords. I will not
disclose my computer passwords to unauthorised persons.
_____ I understand that I am responsible for preventing unauthorised access to or use of my
keys, passwords, and alarm codes.
_____ I understand that I am bound by these policies, even upon resignation, termination, or
completion of my activities.
I agree to abide by the HIV/AIDS Programme Confidentiality Policy. I have received, read,
understand, and agree to comply with these guidelines.
Warning: Persons who reveal confidential information may be subject to legal action by
the person about whom such information pertains.
Supervisor's Signature Date