Safe Tables Terms & Conditions

By participating in this Safe Table I agree to perform Patient Safety Activities, such as presenting, reviewing, analyzing, and participating in deliberations about Patient Safety Work Product within the Garden State Patient Safety Center Patient Safety Evaluation System as Garden State Patient Safety Center temporary volunteer Workforce. My term of service as Garden State Patient Safety Center Workforce terminates at the end of this Safe Table. I understand that this Safe Table is conducted in a safety culture where the focus is on systems or gap analysis and not on individual provider performance. All Patient Safety Work Product is confidential and shall not be disclosed except to provide feedback for quality improvement purposes. I understand that I will be participating in confidential conversations about sensitive confidential data that are intended to improve the quality of care at my health system/hospital. If I am disclosing information from my health system/hospital, I have permission to disclose the data and have removed any PHI and identification of any specific healthcare provider.

I understand that Confidentiality training and other rules for participating in the Safe Table will be provided to me at the beginning of the meeting. I agree that the confidentiality protections of Patient Safety Work Product shall survive after the meeting is adjourned, and I will not disclose any Patient Safety Work Product discussed at this meeting except for quality improvement purposes within the organization that I am representing at this Safe Table. If this meeting is occurring via conference call or Webex, I understand that I am responsible for taking reasonable steps to ensure that no impermissible disclosures occur at the location that I am participating in the meeting.

I recognize that 21 C.F.R. Part 3 provides for penalties - that I can be personally responsible for up to $11,000 for each impermissible Disclosure of Patient Safety Work Product – other than to provide feedback to the facility for quality improvement purposes.

I agree to the terms and conditions in this agreement.