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THIS AGREEMENT made in Duplicate as of the day of , 20 .
BETWEEN:
THE UNIVERSITY OF MANITOBA
Department of Physical Therapy
(hereinafter referred to as the "University")
-and-
(hereinafter referred to as the
"Clinical Facility/Agency")
WHEREAS it is in the mutual interests of the University and the Clinical Facility/Agency that the
development of Physical Therapy (P.T.) be furthered through the educational preparation of
physical therapy students (hereinafter referred to as the “students”) of the University by way of
clinical experience at the Clinical Facility/Agency (hereinafter, the “clinical placement”).
NOW THEREFORE this Agreement witnesseth that in consideration of the mutual covenants
herein contained the parties hereto agree that:
1. Term. This Agreement shall commence on .
2. Liaison. Liaison between the University and the Clinical Facility/Agency shall be by and
through the following persons:
(a) on behalf of the Clinical Facility/Agency, the Clinical Facility/Agency Director or
Designate,
(b) on behalf of the University, the Academic Clinical Co-ordinator, Physical Therapy
Department, School of Medical Rehabilitation or designate,
(collectively referred to as the "Liaison").
The Liaison will meet in person or consult by telephone on a regular and planned basis.
3. Responsibilities of Liaison. The Liaison shall plan in advance of the expected
commencement dates of each academic year, preferably two (2) or three (3) months in
advance, for the clinical education program of the students at the Clinical Facility/Agency
(the "Program").
The Liaison shall make any changes relating to the Program, which are required during the
course of each academic term.
4. Responsibilities of University. The University shall endeavour to present to the Clinical
Facility/Agency as early as possible all necessary relevant information including:
a) the number of students being placed in the Clinical Facility/Agency;
b) the respective education levels of the students;
c) the days and times of the student’s attendance;
d) the names and telephone numbers of academic staff members at the University who
will be involved with the Clinical Facility/Agency;
e) the Physical Therapy Department Clinical Education Policies;
f) a summary of the relevant academic components of the curriculum;
g) the Physical Therapy Department's expectations regarding the type of clinical
experience to be provided at the Clinical Facility/Agency;
h) confirmation that the students have received training on the Personal Health
Information Act (PHIA);
i) completed Provincial Child Abuse Registry Check. The student will be responsible
for providing proof of a Provincial Child Abuse Registry Check prior to
commencement of the clinical placement; and
j) completed Criminal Record Check. The student will be responsible for providing
proof of a Criminal Record Check prior to commencement of the clinical placement.
5. Orientation Period. The Clinical Facility/Agency and the University will plan and conduct
a period of orientation to the clinical placement for the students prior to the beginning of the
clinical placement. The parties contemplate that the orientation information will include the
presentation of selected current policies as well as such regulations and procedures as the
parties deem appropriate.
6. Facilities. The Clinical Facility/Agency will provide to the best of its' ability for the
students, without charge to the University, such facilities at the Clinical Facility/Agency as
are reasonable and appropriate including desks, telephones, lockers or change rooms, access
to a cafeteria and/or eating room, class and/or conference rooms, use of a library and a
parking space (to be provided free only if no parking charge is paid by other persons).
7. Clinical Facility/Agency Responsibilities. The Clinical Facility/Agency shall be
responsible for:
a) clinical instruction and supervision of the student during each clinical placement;
and
b) completion of such evaluations and reports as required by the University.
8. Workers Compensation. As students under the Workers Compensation Act (Manitoba),
students engaged in practicums who are resident in Manitoba are covered for physical
injuries in accordance with and subject to the provisions of the Workers Compensation Act.
In the event of an injury during the practicum the Field Site Supervisor should promptly
contact the University Liaison to ensure that coverage under the Workers Compensation Act
is secured.
9. Indemnification. The University shall indemnify and save harmless the Clinical
Facility/Agency and its officers, servants and agents from every action, suit or claim in
respect of any injury, loss or damage resulting from the grossly negligent acts or omissions
by the University, its officers or servants, when acting within the scope of their employment
or by the students when acting within the scope of the clinical placement, except to the
extent that injury, loss or damage is caused by the act or omission of the Clinical
Facility/Agency, or any of its officers, servants or agents.
10. Termination. This Agreement may be terminated any time by either party giving four (4)
months written notice to the other party, provided, however, any scheduled clinical
placement will not be terminated prior to completion (except where just cause exists in
relation to any individual student’s conduct during the corresponding clinical placement as
reasonably determined by the parties after mutual consultation).
11. Amendments. The parties may amend any provision of this Agreement at any time upon
mutually so agreeing in writing.
12. Risks. The Clinical Facility/Agency shall, in keeping with its responsibilities to its’ clients
and patients, have the right to intervene in those instances where a student may be
functioning in a manner considered by the Clinical Facility/Agency to be of potential risk to
the well-being of the clients or patients, or, contrary to the Clinical Facility/Agency’s
regulations, rules policies or procedures. In such event, and at the Clinical
Facility/Agency’s request, the University and Clinical Facility/Agency shall mutually
consult and determine whether a student will be withdrawn from a placement if requested
by the Clinical Facility/Agency.
13. Notice. All notices to be given by either party to the other under this Agreement shall be
delivered, or mailed by registered or certified post (postage prepaid) addressed to such other
party respectively as follows:
If to the Clinical Facility/Agency:
If to the University:
With respect to amendment or termination of this Agreement:
The University of Manitoba
Dean’s Office, Faculty of Medicine
260 Brodie Centre
727 McDermot Avenue
Winnipeg, Manitoba R3E 3P5
With respect to day-to-day administration of this Agreement:
Academic Coordinator of Clinical Education
Department of Physical Therapy
School of Medical Rehabilitation
R106 – 771 McDermot Avenue
Winnipeg, MB R3E OT6
14. Counterparts. This Agreement may be executed in any number of counterparts and by
different parties in separate counterparts, each of which when so executed shall be
deemed to be an original and all of which taken together shall constitute one and the same
agreement. Delivery by facsimile or by electronic transmission in portable document
format (PDF) of an executed counterpart of this Agreement is as effective as delivery of
an originally executed counterpart of this Agreement.
IN WITNESS WHEREOF the parties have hereto executed this Agreement on the day and year
first above written.
THE CLINICAL FACILITY/AGENCY THE UNIVERSITY OF MANITOBA
Per: Per:
Administrator Dean, Faculty of Medicine
(Print name beside signature)
Recommended By:
Director, School of Medical
Rehabilitation
F:\LEGAL OFFICE\Precedents\Website Documents\Signing Policy\Physical Therapy Field Placement Agmt April 2010 .doc
