CONFIDENTIALITY AGREEMENT
Title of Research Project:
Local Principal Investigator:
As a member of this research team I understand that I may have access to
confidential information about study sites and participants. By signing this statement, I
am indicating my understanding of my responsibilities to maintain confidentiality and
agree to the following:
§ I understand that names and any other identifying information about study sites
and participants are completely confidential.
§ I agree not to divulge, publish, or otherwise make known to unauthorized persons
or to the public any information obtained in the course of this research project
that could identify the persons who participated in the study.
§ I understand that all information about study sites or participants obtained or
accessed by me in the course of my work is confidential. I agree not to divulge
or otherwise make known to unauthorized persons any of this information, unless
specifically authorized to do so by approved protocol or by the local principal
investigator acting in response to applicable law or court order, or public health or
clinical need.
§ I understand that I am not to read information about study sites or participants, or
any other confidential documents, nor ask questions of study participants for my
own personal information but only to the extent and for the purpose of performing
my assigned duties on this research project.
§ I agree to notify the local principal investigator immediately should I become
aware of an actual breach of confidentiality or a situation which could potentially
result in a breach, whether this be on my part or on the part of another person.
______________________________ ________________ _____________________
Signature Date Printed name
______________________________ ________________ _____________________
Signature of local principal investigator Date Printed name
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