Remote Access Request and Confidentiality Agreement

Information Technology

Remote Access Request and Confidentiality Agreement

This form is for PCC employees to request permission to remotely access the PCC systems specified below. For vendors and contractors, there is a separate vendor access process.

This agreement must be renewed annually and at the end of the employment period, whichever comes first. By submitting this form, the employee attests that they have reviewed and understand the PCC’s Technology & Acceptable Use Policies and agrees to the following provisions in order to keep controlled sensitive data (PII, PHI, HIPAA, FERPA, GLBA, etc.) safeguarded.

"*" indicates required fields

Confidentiality agreement

By submitting this form, the employee agrees to keep personal information confidential and to the following provisions:

I will protect my password from use or theft by others.
I will use up to date security products such as a firewall, anti-virus, and anti-spyware applications if accessing PCC from a personally owned computer.
If using a PCC system, I will sign off the system when I leave the workstation and not allow others to use my access. I will only access information on students/employees for whom I have direct responsibility.
I will share personal information only with people who have a right to access the information in order to perform their job function.
When sharing information with people who have a right to access the information in order to perform their job function, I will ensure that I am in a private setting where others cannot hear or see the confidential information.
I will follow all College rules of conduct whenever regarding electronic communications.
I will password protect any mobile computing device that contains PCC critical information or used to access remote services.
I will not disseminate confidential information from my home computer without appropriate authorization for release of information.
I will dispose of confidential information properly in accordance with all applicable policies.
I understand that audits will be performed on computer usage to ensure compliance with all computer related policies and this confidential agreement.
I will follow other specific confidentiality rules for special situations.
When departments have standards more stringent than this statement, I will abide by their standards.
I understand that PCC has the right to investigate and take disciplinary including termination of my employment for breaches of confidentiality.

Employee Information

Employee name*

First Last

Employee PCC email*

Employee department*

Employee type*

Employee support responsibilities*

Please describe the service you are supporting for PCC.

Manager authorization

A Portland Community College manager must authorize each request:

Manager's name*

First Last

Manager's PCC email*

Manager's phone*

Access request

Please list the services and systems to which you need remote access and how will you use them for your job. Be as detailed as possible and fill out the form to the best of your knowledge.

Services*

Banner access*

Will you be accessing Banner remotely? If yes, indicate reason for remote Banner access below:

Telecommuting - Need access to support working remote as part of regular schedule. Telecommuting agreement has been completed.

Overtime/Additional Work - Need access to do additional work outside normal business hours/location. Overtime has been pre-approved by the manager.

Short Term - Need access for a limited time i.e. while attending a conference.

Other

I will not be using Banner remotely

Short Term dates*

Please provide dates needed:

Other Banner access*

Comments

This field is for validation purposes and should be left unchanged.