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This Agreement made as of the day of , 20.

Between:

The University of Manitoba

Faculty of Social Work

(hereinafter referred to as the "University")

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(hereinafter referred to as the "Field Instruction Site")

Whereas it is in the mutual interest of the University and the Field Instruction Site to further the opportunities for the development of social work practice through field instruction of the students of the University, this Agreement witnesses that the parties named above, hereto agree that:

1. This agreement shall commence on .

2. Liaison between the University and the Field Instruction Site shall be by and through the following persons:

(a) the Chief Administrator of the Field Instruction Site or his/her delegate, on behalf of the Field Instruction Site, and

(b) the Dean of the Faculty of Social Work, or delegate, on behalf of the University; (collectively referred to as the "Liaison").

The Liaison shall communicate on a regular and planned basis, as required, to facilitate the student field instruction experience.

3. The Liaison shall plan in advance of the expected commencement dates of each academic year, preferably at least two or three months in advance, for the field work program of the University students at the Field Instruction Site (the "Program"). This will include sufficient learning opportunities to enable the student to meet the Program requirements as identified in a "Student Evaluation Document”, which may be amended from time to time, and which is provided to students annually or at the beginning of their Program, hereby incorporated by reference into this Agreement. The Liaison shall make any changes relating to the Program which are required during the course of each academic year.

4. Prior to the commencement of each academic year, the University and the Field Instruction Site will confirm the number of students to be placed at the latter during the academic year.

5. The Field Instruction Site will be responsible for both administrative supervision and field instruction for the aforementioned students. The staff of the Field Instruction Site (the "Site Staff") assigned to provide the field instruction shall be determined by mutual agreement of the Liaison. The specific responsibilities of the Site Staff will be those designated under sections entitled “The Field Instructor” and “Agency Resource Person” in a document entitled “Roles of the Key Persons in the Field Instruction Process”, as amended from time to time and which document is located within a manual which has been provided to the Field Site, hereby incorporated by reference into this Agreement.

6. Prior to the commencement of each academic year, the University will submit to the Chief Administrator of the Field Instruction Site or delegate the following:

(a) the number of students and level of Field Program required by each student;

(b) student time tables, indicating the number of days that the students will be involved in the Program.

7. The Liaison will plan and conduct a period orientation to the Program at the commencement of the academic year of the Program. It is contemplated by the parties that the orientation period will include the presentation of appropriate current policies, including codes of professional conduct, as well as such regulations and procedures as the parties deem appropriate.

8. The Field Instruction Site will provide for the students without charge to the University:

(a) such facilities as desks, file cabinets, telephones, utilization of meeting rooms, and the like, as is feasible and appropriate for the carrying out of responsibilities related to the Program, as well as .

(b) reimbursement for transportation and out of pocket expenses borne by students consistent with reimbursement practices of the Field Instruction Site for its own staff.

9. As students under The Workers Compensation Act (Manitoba) (the “Workers Compensation Act”), students engaged in the Program are covered for injuries in accordance with and subject to the provisions of the Workers Compensation Act. In the event of an injury during the Program, the Field Instruction Site Liaison should promptly contact the University Liaison to ensure that a report and claim can be made to the Workers Compensation Board.

Where the location of the Field Instruction Sites is outside of the Province of Manitoba, and students engaged in the Program are not resident in Manitoba, the University shall provide to its students insurance for workplace injury or accident through the Canadian University Reciprocal Insurance Exchange (CURIE) Student Accident & Injury Coverage Program.

10. The University shall indemnify and save harmless the Field Instruction Site 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 employees or agents, when acting within the scope of their employment or by its students when acting under the direction of the University, except to the extent that injury, loss or damage is caused by the act or omission of the Field Instruction Site or any of its site staff, employees or agents.

11. The Field Instruction Site shall indemnify and save harmless the University from every action, suit or claim in respect of any injury, loss or damage resulting from the grossly negligent acts or omissions by the Field Instruction Site, its employees or agents, when acting within the scope of their employment, except to the extent that injury, loss or damage is caused by the act or omission of the University or any of its employees or agents.

12. This Agreement may be terminated any time by either party giving six clear months notice to the other party, provided however that the Program will not be terminated prior to the completion of the then current academic year (except where just cause exists in relation to any individual student’s conduct during the corresponding clinical/fieldwork placement as reasonably determined by the parties after mutual consultation).

13. The parties may amend any provision of this Agreement at any time upon mutually so agreeing in writing.

14. All notices to be given by either party to the other under this Agreement will be mailed and addressed to such other party respectively as follows:

if to the Field Instruction Site:

Attention:

if to the University:

Attention: Dean of Social Work

The University of Manitoba

Faculty of Social Work

Room 521 Tier Building

Winnipeg MB R3T 2N2

15. 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 hereto have duly executed this Agreement on the day and year first above written.

THE UNIVERSITY OF MANITOBA

Per:

Dean, Faculty of Social Work

Per:

, Executive Director

F:\LEGAL OFFICE\Precedents\Website Documents\Signing Policy\Standard Field Placement Agreement - Social Work(student not resident in MB) May 2011.doc