HomeMy WebLinkAbout2025-714-E-Emergency Svc-Johnston Community College-Student Clinical
Clinical Affiliation Agreement
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Agreement for Clinical Affiliation
between
Johnston Community College EMS Education Program
and
Orange County Emergency Services
This agreement made and concluded the 10th day of November 2025 by and between the Board of
Trustees, of
Johnston Community College and Orange County Emergency Services
Administrative Agency Service Agency
chartered and doing business under the laws of the State of North Carolina with its principal office in
the city of Hillsborough county of Orange.
WITNESSETH
WHEREAS, the Administrative Agency has passed a resolution to establish and operate a program in
Emergency Services in Cooperation with the North Carolina State Board of Education, Department of
Community Colleges, Technical Division, and;
WHEREAS, in order to facilitate such programs, the use, assistance, and cooperation of a Service
Agency is necessary, and the above Agency has agreed to act in such capacity;
NOW, THEREFORE, in consideration of the mutual obligation stated hereinafter below and the
benefits according to each of the parties hereto, the administrative Authority and Service Agency do
hereby enter into this agreement:
1. Johnston Community College operated by the Board of Trustees (Education) shall annually
arrange for the attendance of one or more instruction classes of EMS Interns in the Service
Agency, to begin November 10, 2025 and to end June 30, 2027, unless ninety days (90) prior to
the end of any term either party shall notify the other of its intention to terminate the within
agreement at the end of the current term. Renewal agreements shall be entered into at least
ninety days (90) prior to the expiration of the current agreement;
2. This agreement, except for provisions of termination, may be altered by written consent of both
parties.
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Clinical Affiliation Agreement
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CONDITIONS OF AGREEMENT
I. Agreement
A. This is a mutual agreement between the administrations of
Johnston Community College and Orange County Emergency Services
Administrative Agency Service Agency
B. The Service Agency will accept faculty and interns for clinical learning experiences.
EMS interns in the EMS Education Program shall be the responsibility of the faculty of
the EMS Education Program of Johnston Community College.
C. The Service Agency maintains the right to withdraw permission for clinical affiliation
for any intern and/or faculty if it is determined by the Service Agency that clinical
performance and/or behavior is detrimental to the agency work environment, property,
and/or patient care. It is understood that decisions to dismiss faculty and/or interns is the
ultimate responsibility of the Administrative Authority.
D. The faculty shall work in close relationship with the Service Agency Administrator and
staff through the Clinical Coordinator of the EMS Education Program. The faculty shall
be responsible for the orientation, rotation through services areas, selecting patient
assignments, supervision, and evaluation of the interns during patient care experiences at
the Service Agency.
II. The Service Agency agrees to:
A. Accept faculty and intern, providing the opportunity for the practice and experience as
required by appropriate accrediting and approval bodies in accordance with the master
plan for the curriculum.
B. Have equipment and supplies suitable in quantity and quality, properly maintained and
available for use.
C. Make records of those served available for use by faculty and interns.
D. Refer to the Administration Agency any intern found to be lacking in ability to develop
qualities essential for practice, for ill health, or for failure or unwillingness to conform to
the regulations and routines of the Service Agency, as well as the right to recommend
withdrawal of any intern for reasons of unsatisfactory performance, violations of
policies, and/or misconduct.
E. Designate a clinical preceptor or instructor to oversee all clinical instruction and to serve
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Clinical Affiliation Agreement
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as liaison between Johnston Community College and Service Agency. Acceptable
preceptor-to intern or faculty-to intern ratios will be determined jointly by the Service
Agency, Medical Director, EMS Advisory Committee, Clinical Coordinator and
accrediting/approving bodies.
F. Encourage the staff of the Service Agency to support the purpose of this educational
program.
G. Provide health care and emergency health services when interns are injured or become ill
while participating in learning experiences. The interns will incur the expense for these
services.
H. Provide a confidentially meeting place for intern review and evaluation.
I. Assist the Administrative Agency in ensuring all preceptors complete the EMS Program
Preceptor requirements.
J. Retain full responsibility and authority for the care and treatment of its patients while
interns receive clinical instruction and/or are engaged in precepted clinical learning
experiences.
III. The Administrative Agency agrees to:
A. Enroll interns in the EMS Education Programs in accordance with the standards
established by the North Carolina Office of EMS and other accrediting and approval
bodies.
B. Employ qualified faculty for the EMS Education Program. One member of the faculty
will be responsible for coordination of the total program curriculum and will be known
as the Director. Faculty responsibilities are to be established by the Administrative
Officer of Johnston Community College.
C. Require faculty and interns to adhere to established agency policies, routines, and
regulations.
D. Provide preceptor training to all preceptors on the program goals and evaluation process.
E. Inform interns that as a condition of participation, interns will be required to perform or
have performed a criminal background check and make results available for review to
the Service Agency. The criminal background check will include both felonies and
misdemeanors for the past seven (7) years and within any state and county the intern has
resided during the past seven (7) years. Service Agency reserves the right to not accept
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Clinical Affiliation Agreement
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any intern for participation in an Experience at Service Agency who has a criminal
record.
F. Conduct drug & alcohol screening on all interns assigned to clinical rotations at the
Service Agency under this agreement. The drug screening should include at least the
following: AMP (amphetamine), BAR (barbiturates), COC (cocaine), THC (marijuana)
OPI (opiate) and PCP (Phencyclidine). The results will be available for review by the
Service Agency.
G. Maintain a preceptor-intern ratio in accordance with North Carolina Office of EMS and
other accrediting and approving bodies.
H. Schedule clinical experience with the Service Agency point of contact two to four weeks
prior to the clinical opportunity.
I. Require interns to wear the adopted EMS program uniform and ID badge.
J. Require interns to comply with policies and procedures regarding personal appearance
and hygiene while participating in clinical opportunities.
K. Require interns absent from the clinical area to inform the clinical preceptor or
supervisor no later than one hour prior to the assignment.
L. Dismiss any intern from the Service Agency who presents problems in physical or
emotional health, and/or demonstrates behaviors which conflicts with safety essential to
clinical practice.
M. Plan the total curriculum as guided by the North Carolina Office of EMS and other
accrediting and approval bodies. The preceptor will have the primary responsibility for
the appropriate assignment, supervision, and evaluation of interns in the clinical
opportunity to carry out the purposes and functions of the program goals.
N. Collaborate with designee of the Service Agency for input into planning of curricula and
clinical learning experiences.
O. Require all interns to obtain and maintain professional liability insurance, which pays up
to $2 million for each claim up to a total of $5 million in any one year.
P. Require interns to complete a Blood-borne Pathogen Program compliant with 29 CFR
1090.1030. This program shall include:
i. Training on blood-borne pathogens to include Standard Precautions prior to
clinical experiences. (29 CFR 1910.1030(g)(2))
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Clinical Affiliation Agreement
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ii.Hepatitis B vaccination program. (29 CFR 1910.1030(f)(2))
iii.Provide a contact with 24-hours availability for notification of intern exposures.
Q. Require interns to complete a Tuberculosis (TB) Control Program consistent with the
Centers for Disease Control Guidelines for Preventing the Transmission of Tuberculosis
in health-care setting, to include:
i.Assurance that all interns who participate in clinical experiences are screened for
TB prior to any clinical opportunities and annually thereafter.
ii.Assurance that all interns have received education and training about TB prior to
any clinical opportunities.
R. Require interns to maintain current BLS certification through the AHA.
S. Require interns to complete instruction and abide by Confidentiality & HIPPA laws.
T. Require interns to submit documentation of the following immunization:
i.Measles (Rubeola)-Mumps-Rubella (MMR): Proof of two vaccines or a positive
titer indicating immunity.
ii.Varicella (Chicken Pox): Proof of vaccine or a positive titer indicating immunity.
iii.Hepatitis B: Proof of vaccines or Hepatitis B declination form
iv. Tuberculosis: Negative skin test, negative chest x-ray or QuantiFERON TB Gold
(QFT) blood results.
v. Tetanus, Diphtheria & Pertussis (Tdap): Proof of vaccine < 10 years
vi. Influenza: Current vaccine for flu season
U. Require interns to participate in routine daily duties of the Service Agency, to include:
i.Ambulance and equipment check-off
ii.Ambulance, equipment, and station maintenance/cleaning
iii.In-service training activities
iv. Community service and education events
V. In the event, the Administrative Agency enters into another clinical affiliation agreement
with another private organization; the Administrative Agency will monitor each intern to
ensure interns do not sign-up for clinical opportunities with different organizations.
W. As stated in NCGS 115D-24 Johnston Community College (JCC) waives immunity from
liability for negligence of agents and employees of JCC by obtaining liability insurance
as provided in G.S 115D-53 G.S for the death or injury of person or for property damage
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Clinical Affiliation Agreement
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caused by the negligence or tort of any agent or employee of the board of trustees when
the agent or employee is acting within the scope of their authority or the course of
employment.
THIS AGREEMENT is made and entered into and executed by the proper officers pursuant to
the adoption of a resolution by the Board of Trustees of Johnston Community College at a
regular meeting, thereof held on June 1, 1978.
IN WITNESS WHEREOF, The Board of Trustees (Education) has caused this agreement to be
executed by its Chairman and Administrative Officer, who have affixed the seal of the Board
hereto, and the Service Agency, which has caused this agreement to be executed by its
Administrator, who is duly authorized to do so in behalf of the Agency.
Johnston Community College Orange County Emergency
Services
Administrative Agency Service Agency
Smithfield, NC - Johnston Hillsborough, NC
City, State & County City, State & County
Julia B Harrison W. Kirby Saunders, Director
__________________ VP Finance and Operations Service Agency Representative
______________________________ ______________________________
Signature Signature
Click or tap to enter a date. ____ ____ ____
Date Date
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
11/11/2025 11/11/2025
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
Revised 01/24
1
ORANGE COUNTY—INTERNAL USE ONLY
______________________________________________________________________________
Finance Information
Vendor Name: Johnston Community College Vendor Contact Person: Shannon Wright Phone: (919) 464-2458
Address: 245 College Rd. City Smithfield State: NC Zip: 27577 Department: Emergency Services Amount: 0
Purpose: Student Clinical Budget Code(s): Vendor #
Vendor Status with NCSOS: 0078733 Vendor is a BOCC consultant: Yes No
Contract Details
Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment )
Effective Date End Date Notice Date (Notice Purpose )
Award
Approved by Board (Agenda Date: ); Made or Administered by
Signature Authority
- BOCC Express Delegation (Agenda Date: )
- Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000
- Budget Policy Section XV (Capital Improvement Project: )
Bidding
Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# )
Department Affirmation
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement.
This agreement is approved as to technical form and content. Services related to this agreement have already
begun or been completed. Description of the nature of the emergency condition that was addressed:
Department Director’s Signature ________________________________________ Date: ________
Information Technologies
This agreement has been reviewed and is approved as to information technology content and specifications:
Office of the Chief Information Officer___________________________________ Date: ________
Inapplicable because no hardware/software purchases or related services
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
Clerk to the Board
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Received for record retention:
Office of the Clerk to the Board __________________________________________Date:_________
Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4
11/11/2025
11/13/2025
11/25/2025