Annual Policy Review & No-Convictions Statement

Annual Policy Review & No-Convictions Statement

Thank you for all you are doing for our precious seniors.  To continue to keep you abreast of the policies of 360 SHS and to honor the requirements of the Department of Health and Human Services (licensing body) annually, all Providers must complete a review of several 360 SHS policies, and sign a no-convictions statement.  This is to be completed by every Provider in the month of September each year, regardless of when the Provider started employment.  Please follow the steps below and then sign off at the bottom.  Click on each document, read carefully.  Thank you!!

1) Click to read 6E Bill of Rights.Rev 09.14

2) Click to read 28 Infection Control and Compliance Issues

3) Click to read RACE

4) Click to read 12 Non Compete Agreement – Employee

5) Click to read 26 Incidents and Complaints

6) Click to read 13 Position Description – Provider Responsibilities 2020

7)  Click to read  57 HIPAA Online

8) Click to read 58 Mandatory Reporting

9) Click to read (and watch the training video) 35 Substance Abuse and Drug Free Workplace Policy

10) Read and sign below
____________________________________________________________________

Type Full Name *

Email Address *

Date *

Client Rights & Responsibilities *

I have carefully read and understand the 360 SHS policy on client rights and responsibilities.

Infection Control & Safety *

I have carefully read and understand the 360 SHS policy on infection control. Furthermore, regarding all safe practices I have been given a copy of the 360 SHS Safety Policy and that policy is also available to me through the Provider Resources Page of this website.

RACE *

I have carefully read and understand RACE and will follow fire safety procedures.

Emergency Procedures *

I have carefully read and understand the 360 SHS policy on emergency procedures. (See Safety Policy you received at your Pre-Hire Program.)

No Convictions Statement

I do not have a felony conviction in this or any other state. I have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a client. I have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

Non Compete Agreement *

I understand I signed a Non Compete Agreement with 360 SHS upon employment. I have re-read the above Agreement. I commit to refer all service requests from 360 SHS clients to the 360 SHS office. I also agree I will not privately engage in any competing services with 360 SHS current, potential or former clients during my employment and for one year after my termination with 360 SHS.

Incidents & Complaints *

I have carefully read and understand 360 SHS policy on Incidents & Complaints

Position Description *

I have carefully read and understand the responsibilities and position description for a Caregiver.

HIPAA *

I have carefully read and understand how HIPAA guides the use of Personal Health Information (PHI) and agree to follow all HIPAA regulations.

Mandatory Reporting *

I have carefully read and understand 360 SHS policy on Mandatory Reporting.

Substance Abuse and Drug Free Workplace Policy *

I have carefully read and understand 360 SHS policy on Substance Abuse and Drug Free Workplace. And I have participated in the annual training.

Type Your Name (this is your signature) *