Skip to main content

Video Record Use and Confidentiality Agreement



 Midwestern University is committed to quality education and training. Toward this end, students are routinely observed and evaluated directly or through Video Records*.  Because video recording creates a potentially enduring record of images, the following document describes the policies regarding use of such records, confidentiality, security, and record retention.  An additional section is included for individuals with the potential to be recorded.

These policies must be understood and adhered to by all students, faculty and staff.  

1)      All Video Records generated within the Clinical Skills and Simulation Center (CSC) are maintained on a private network server within the CSC server room. Firewall protection is maintained according to accepted standards of Midwestern University.  Access to the server room is limited to the Center Director and authorized IT staff.  Access to all Video Records is password protected.

2)      Video Record viewing is controlled on a need-to-view basis.   Only those Midwestern University faculty or staff, with a legitimate educational need (ordinarily those faculty or staff associated with the CSC and/or the educational program, course or curriculum for which that Video Record was generated) will have access to Video Records
3)      The Center Director in conjunction with the originating course director and the CSC Simulation Technologist will manage the permission to view and use Video Records by authorized faculty, staff, and/or students. Any other use of Video Records requires permission and authorization as described within this agreement.  
4)      Regardless of accessibility, no faculty or staff will view or use any Video Records without first submitting a duly executed and signed Video Record Use and Confidentiality Agreement.
5)      Video Records obtained in the course of education can be used to:
·         Provide feedback to students to improve their performance;
·         Formally assess student achievement and/or competency;
·         Help evaluate and improve college or program curriculum; 
·         Evaluate and improve our teaching and assessment processes using human and non-human simulations;
·         Aid in the teaching of future students (Institutional Purpose);
·         Research (Scholarly Purposes)
6)      In instances when Video Records may be used for Institutional Purposes and there is a recognizable image of a student, faculty, or Standardized Patient (SP), written permission of those individuals will be obtained prior to the use of any such images.  This permission will stipulate the specific use(s) of the Video Records, including the duration of use.  The individual(s) reserves the right to agree or disagree to its use with or without stipulations. Such stipulations may include limitation to specified use(s) or the de-identification of features or voice so as to diminish the likelihood of recognizing the identity of the individual.  All stipulations will be documented in the consent. Even after such consent has been granted, individuals retain the right to revoke their consent at any time.
7)      In instances when for Scholarly Purposes Video Records and/or data obtained from them may be used for research, IRB review and approval is required.   Depending on the nature of the proposed research, the IRB may or may not require written informed consent from individuals with recognizable images.  Regardless, all research personnel who have access to Video Records must still be authorized for such access as specified above.  IRB-approved uses of Video Records may include retention policies that are different than those described herein and will prevail in these circumstances.
8)      Video Records will be maintained in accordance with Midwestern University Record Retention and Destruction Policy.
·         Video Records that are not a part of a student’s permanent record will be retained until electronically destroyed, normally one year following the student’s graduation or within one year of the end of the student’s tenure as a designated Midwestern University student, whichever comes first. 
·         Video Records that are considered a part of an official student record or portfolio such as those created during high-stakes assessments (i.e., those that regulate student progress through a MWU curriculum) may be retained longer, as outlined in the Midwestern University Record Retention and Destruction policy.

9)       Any copying, duplication, or other form of distribution of audio or video footage released by the CSC is prohibited.  Violation of this policy may result in student dismissal or faculty/staff termination.

Consent for Video Recording (for student, faculty, SP)

I, _______________________________ hereby authorize the Midwestern University Clinical Skills and Simulation Center to video record me for the purpose of teaching, learning, review, and evaluation.  I hereby assign all rights to the release and retention of Video Records to the Clinical Skills and Simulation Center as outlined in this agreement.  I understand that Video Records will be used for educational purposes only.  Any other use will require specific written permission.  _____ Initials
I certify that I am over 21 years of age.    ______ Initials


                                                          ____________________________________                                                                       
                                                                        Signature of User                                Date



                                                                        ____________________________________
                                                                       
                                                                        Signature of Witness                            Date



                                                                        ____________________________________

                                                                        Signature of CSC Director                  Date
see more: https://templateshunter.com/business-operations.html


Comments

Popular posts from this blog

PERMISSION RELEASE

TEDx______ (“TEDx______”) will be recording all the presentations at the TEDx______   event to be held [Date, Year] (the “Event”). TEDx_______ is operated under license of TED Conferences LLC (“TED”). Beyond the Event, the goal of both TED and TEDx ___, is to spread great ideas, by making these presentations freely and widely available to a global audience. This release (the “Release”) will serve as our agreement concerning your participation at the Event.   In consideration for the platform provided to you, and in support of the goal of “ideas worth spreading,” you grant TEDx_____, TED, and other entities — e.g., broadcasters — as TEDx_____ or TED may designate from time to time (collectively, the “TED Parties”) the right to record, stream, film and photograph your presentation at the Event (the “Presentation”) and to distribute, broadcast, edit, translate (as discussed below) or otherwise disseminate it, without any further approval from you, in whole or in par...

Scroll down to the next page for the template. at templateshunter

Release Form I, ______________________, hereby irrevocably consent to and authorize The Ohio State University, through [Department/Program Name/Faculty or Staff Name], other affiliates, licensees, successors and assignees (collectively, “University”), to photograph and videotape me, record my voice, conversation, sounds, images and likeness during and in connection with [project/course/conference name]. I hereby grant all rights to the University to use the results of such videotaping, photography, and recording, including my name and biographical information, in perpetuity, throughout the world. I understand that the University may duplicate and distribute this video or likeness in whole or part worldwide for research, educational, or non-commercial purposes. I waive the right to receive any payment for signing this release and waive the right to receive any payment for the University’s use of any of the material described above or any of the purposes authorized by this release. I...

Affidavit of Identity

https://templateshunter.com/business-operations.html The Kentucky Legislative Research Commission’s Program Review and Investigations Committee issued a report in April 2009 in which it made the following recommendation: “Recommendation 3.1: The Kentucky Department of Education should identify the information public schools may legally require or request of first-time enrollees. The department should facilitate and monitor compliance by all Kentucky school districts.” In response, Kentucky Department of Education (KDE) is providing the following guidance regarding acceptable forms of identification for students upon initial enrollment in a school in Kentucky. Kentucky law guarantees that every child satisfying the age requirements and residing within the state can attend a public elementary or secondary school. [1] KRS 158.030 (emphasis added) provides: “Common school” means an elementary or secondary school of the state supported in whole or in part by public taxation. No...