Nursing Home Employee Code of Conduct Acknowledgment Form

I, [Employee Name], hereby acknowledge that I have received and read the Nursing Home Employee Code of Conduct for [Your Company Name]. I understand that as an employee of [Your Company Name], I am expected to adhere to the highest standards of professionalism, ethics, and integrity while carrying out my duties within the facility.

By signing this acknowledgment form, I commit to upholding the following principles and responsibilities:

1. Respect and Dignity: I will treat all residents, their families, and fellow employees with respect, compassion, and dignity, recognizing their individuality and diversity.
   

2. Confidentiality: I understand the importance of maintaining the confidentiality of resident information and will not disclose any personal or medical information unless authorized to do so.
   

3. Patient Rights: I will uphold the rights of residents as outlined in state and federal regulations, including the right to privacy, autonomy, and dignity.
   

4. Safety and Hygiene: I will adhere to all safety protocols and infection control measures to ensure the health and well-being of residents, visitors, and fellow staff members.
   

5. Professionalism: I will conduct myself in a professional manner at all times, demonstrating honesty, integrity, and accountability in my actions and interactions.
   

6. Compliance: I will comply with all applicable laws, regulations, and policies governing healthcare, including those related to patient care, documentation, and reporting.
   

7. Continuous Learning: I will actively engage in ongoing education and training to enhance my knowledge and skills, contributing to the quality of care provided to residents.

I understand that any violation of the Nursing Home Employee Code of Conduct may result in disciplinary action, up to and including termination of employment.

I further acknowledge that I have received appropriate training related to the Code of Conduct and that I am committed to reporting any violations or concerns to the appropriate authorities within the facility.

Employee Signature:

[Date]

Supervisor Signature:

[Date]

(For Office Use Only)

Training Date:                               

Trainer Name:                               

Comments/Notes:                                                                                                           

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