IGA RE DENTAL SEALANT WITH WASHINGTON ESD RVSD.PDF

INTERGOVERNMENTAL AGREEMENT
MARICOPA COUNTY
by and through the
DEPARTMENT OF PUBLIC HEALTH
4041 N. Central Avenue, #1400, Phoenix, Arizona 85012
1. Agreement No: C-86-18-045-3-00 2. Agreement Type: Non-Financial Service Agreement
3. Agreement Amount: $0.00 4. Purpose: Dental Sealant
5. Start Date: January 1, 2018 6. Expiration Date: December 31, 2019
This Agreement is entered into by and between Washington Elementary School District (referred to herein as “School District”),
and Maricopa County, by and through its Department of Public Health (referred to herein after as “County”). School District and
the County are collectively referred to herein as the “Parties” and individually as a “Party.” County, for and in consideration of
the covenants and conditions set forth herein, shall provide and perform the services as set forth below. All rights and
obligations of the Parties shall be governed by the terms of this Agreement, its exhibits, attachments, and appendices, including
any subcontracts or amendments as set forth herein and in:
Section I - General Provisions Section III - Work Statement
Section II - Special Provisions
This Agreement contains all the terms and conditions agreed to by the Parties. No other understanding, oral or otherwise,
regarding the subject matter of this Agreement shall be deemed to exist or to bind the Parties. Nothing in this Agreement shall
be construed as consent to any lawsuit or waiver of any defense in a lawsuit brought against the County or the School District in
any State or federal Court.
Legal Notice under this Agreement shall be given by personal delivery or by registered or certified mail, postage prepaid, return
receipt requested, to the addresses set forth below and shall be effective upon receipt by the Party to whom addressed unless
otherwise indicated in the notice.
Notice to School District: Washington Elementary School District Phone: 602-347-2853
Address: 4650 W Sweetwater, Glendale, AZ 85304
Notice to County: MCDPH Grants/Contract Unit Phone: (602) 372-0674
Address: 4041 North Central Avenue, Suite #1400, Phoenix, Arizona 85012
IN WITNESS WHEREOF, the parties enter into this Agreement:
MARICOPA COUNTY BOARD OF SUPERVISORS
Signature: Signature:
Name: Name:
Title: SUPERINTENDENT Title: Chairman, Board of Supervisors
Date: Date:
ATTEST:
Signature
Clerk of the Board
Date
Pursuant to A.R.S. § 11-952, the undersigned public agency Pursuant to A.R.S. § 11-952, the Attorney for the Board of
attorney has determined that this Intergovernmental Agreement Supervisors has determined that this Intergovernmental
is in proper form and is within the powers and authority granted Agreement is within the powers and authority granted under the
under the laws of the State of Arizona. laws of the State of Arizona.
Signature: Signature:
Attorney for Maricopa County
Name: Name:
Date: Date:
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SECTION I PROVISIONS
1. EFFECT
To the extent the Special Provisions are in conflict with the General Provisions, the
Special Provisions shall control. To the extent the Work Statement(s) and the Special or
General Provisions are in conflict, the Work Statement(s) shall control.
2. DEFINITIONS
As used throughout this Agreement, the following terms shall have the following
meanings:
A. Agreement means this document and all attachments and amendments hereto.
B. School District means the person, firm or organization listed on the Cover Page
of this Agreement.
C. County means Maricopa County, Arizona.
D. Department means the Maricopa County Department of Public Health.
3. GENERAL REQUIREMENTS
A. The terms of this Agreement shall be construed in accordance with Arizona law.
Any lawsuit arising out of this Agreement shall be brought in the appropriate
court in Maricopa County.
B. The County shall, without limitation, obtain and maintain all licenses, permits, and
authority necessary to do business, render services, and perform work under this
Agreement, and shall comply with all laws regarding unemployment insurance,
disability, and workers’ compensation.
C. The County is an independent contractor in the performance of work and the
provision of services under this Agreement and is not to be considered an officer,
employee, or agent of the School District.
4. AMENDMENTS
All Amendments to this Agreement must be in writing and signed by authorized persons
for both Parties. All amendments shall clearly state the effective date of the action.
5. RETENTION OF RECORDS
A. This provision applies to all financial and programmatic records, supporting
documents, statistical records, and other records of the County and School
District, which are reasonably considered as relevant to this Agreement.
B. The County and the School District shall retain all financial books, records, and
other documents related to this Agreement for five (5) years after the expiration
date of this Agreement. County, federal, or State auditors, and any other
persons duly authorized by the County, shall have full access to and the right to
examine, copy and make use of any and all such financial books, records and
other documents.
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SECTION I PROVISIONS
6. ASSIGNMENT AND SUBCONTRACTING
No rights, liability, obligations or duties under this Agreement may be assigned,
delegated, or subcontracted without the prior written approval of the County.
7. AGREEMENT COMPLIANCE MONITORING
School District shall monitor the County's compliance with, and performance under, the
terms and conditions of this Agreement. On-site visits for compliance monitoring may be
made by the School District and/or its grantor agencies at any time during the School
District's normal business hours, announced or unannounced. During an on-site visit,
the County shall make its records and documents related to work performed or services
provided under this Agreement available to the School District for inspection and
copying.
8. DEFAULT
Either Party may suspend, modify, or terminate this Agreement immediately upon giving
written notice to the other Party that said Party has failed to perform under or otherwise
breached any obligation under this Agreement, or upon the occurrence of any event that
may jeopardize the ability of the noticing Party to perform any of its obligations under this
Agreement.
9. TERMINATION
A. Either Party may terminate this Agreement at any time by giving the other Party
at least thirty (30) calendar days prior written notice. The notice shall be given by
personal delivery or by registered or certified mail, postage prepaid, return
receipt requested.
B. This Agreement may be terminated by mutual written agreement of the Parties
specifying the termination date therein.
C. If not terminated by one of the above methods, this Agreement will terminate
upon the expiration date of this Agreement as stated on the Cover Page of this
Agreement.
10. TERMINATION FOR BREACH
If either Party defaults under this Agreement and the default continues for more than ten
(10) days after the effective date of the other Party’s written notice stating the specific
nature of the default, then the noticing Party may treat the default as a breach of this
Agreement. Upon a breach, the aggrieved Party may exercise any remedy available
under the law, including the termination of this Agreement.
11. SEVERABILITY
Any provision of this Agreement that is determined to be invalid, void, or illegal by a
court shall in no way affect, impair, or invalidate any other provision hereof, and the
remaining provisions shall remain in full force and effect.
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SECTION I PROVISIONS
12. STRICT COMPLIANCE
Acceptance by the Parties of performance that is not in strict compliance with the terms
of this Agreement shall not be deemed to waive the requirement of strict compliance for
all future performance. All changes in performance obligations under this Agreement
must be in writing and signed by the Parties.
13. NON-LIABILITY
The School District and its officers, representatives, agents, and employees shall not be
liable for any act or omission by the County or any subcontractor, employee, officer,
agent, or representative of the County or any subcontractor occurring in the performance
of this Agreement, nor shall they be liable for purchases or contracts made by the
County or any subcontractor in connection with this Agreement.
14. INDEMNIFICATION
Each Party (as "indemnitor") agrees to indemnify, defend, and hold harmless the other
Party (as "indemnitee") from and against any and all claims, losses, liability, costs, or
expenses (including reasonable attorney's fees) (hereinafter collectively referred to as
"claims") arising out of the negligent performance of this Agreement, but only to the
extent that such claims which result in vicarious/derivative liability to the indemnitee are
caused by the act, omission, negligence, misconduct, or other fault of the indemnitor, its
officers, officials, agents, employees, or volunteers.
15. COVENANT AGAINST CONTINGENT FEES
The County warrants that no person or entity has been employed or retained to solicit or
secure this Agreement upon an agreement or understanding for a commission,
percentage, brokerage, or contingent fee. For breach or violation of this warranty, the
School District may immediately terminate this Agreement without liability.
16. SAFEGUARDING CLIENT INFORMATION
The use or disclosure by any Party of any information concerning an eligible individual
served under this Agreement is directly limited to the performance of this Agreement.
17. RIGHTS IN DATA
The Parties shall have the use of data and reports resulting from this Agreement without
cost or other restriction, except as otherwise provided herein or by law. Each Party shall
supply to the other Party, upon request, any available information known to the
supplying Party that is relevant to this Agreement and to the performance hereunder.
18. NON-DISCRIMINATION
The County, in connection with any service or other activity under this Agreement, shall
not in any way discriminate against any person on the grounds of race, color, religion,
sex, national origin, age, disability, affiliation or belief. The County shall include this
clause in all of its subcontracts related to this Agreement.
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SECTION I PROVISIONS
19. EQUAL EMPLOYMENT OPPORTUNITY
The County shall not discriminate against any employee or applicant for employment
because of race, age, disability, color, religion, sex, or national origin. The County shall
take affirmative action to insure that applicants are employed and that employees are
treated during employment without regard to their race, age, disability, color, religion,
sex, or national origin. Such action shall include, but is not limited to, the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, lay-
off or termination, rates of pay or other forms of compensation, and selection for training,
including apprenticeship. The County shall, to the extent such provisions apply, comply
with Titles VI and VII of the Civil Rights Act of 1964, as amended (42 U.S.C. §§ 2000a,
et seq.); the Rehabilitation Act of 1973, as amended (29 U.S.C. §§ 701, et seq.); the Age
Discrimination in Employment Act of 1967, as amended (29 U.S.C. §§ 621, et seq.); the
Immigration Reform and Control Act of 1986 (Pub. L. No. 99-603) (“IRCA”); and Arizona
Executive Order 2009-09, which mandates that all persons shall have equal access to
employment opportunities. The County shall also comply with all applicable provisions
of the Americans with Disabilities Act of 1990 (42 U.S.C. §§ 12101, et seq.).
20. RIGHT OF PARTIAL CANCELLATION
If more than one activity is funded by this Agreement, the Parties reserve the right to
terminate this Agreement or any part thereof without impairing, invalidating or canceling
the remaining Work Statement obligations.
21. RIGHT TO EXTEND AGREEMENT
Subject to the availability of funds and acceptable County performance, the Parties
hereby acknowledge and agree that they shall have the right to extend this Agreement
for additional one-year periods, not to exceed a total extended term of five (5) years.
Any extension of this Agreement shall be in writing mutually acceptable to and signed by
both Parties.
22. CIVIL SERVICES DIVISION
The Parties to this agreement acknowledge that they are aware that the Civil Services
Division of the Maricopa County Attorney’s Office (Civil Division) may be chosen as the
attorney for other Parties to this agreement, and the signing Party acknowledges that it
is aware of a potential conflict of interest, and it waives any claim of conflict of interest,
which may arise by virtue of Civil Division’s representation of other Parties to this
agreement.
23. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
A. The undersigned, an authorized representative of the County, certifies, to the
best of his or her knowledge and belief, that the County, defined as the primary
participant in accordance with 45 C.F.R. Part 76, and its principals:
1) are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any federal
department or agency;
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SECTION I PROVISIONS
2) have not within the 3-year period preceding this Agreement been convicted of
or had a civil judgment entered against them for the commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, State or local) transaction or contract under a public
transaction; violation of federal or State antitrust statues or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
3) are not presently indicted or otherwise criminally or civilly charged by a
government entity (Federal, State or local) with the commission of any of the
offenses enumerated in paragraph (2) of this certification; and
4) have not within the 3-year period preceding this Agreement had one or more
public transactions (federal, State or local) terminated for cause or default.
B. If the County is not able to provide this certification, an explanation as to why
shall be attached to this Agreement.
C. The County shall include, without modification, this Paragraph in all lower tier
covered transactions (i.e., transactions with subcontractors) and in all
solicitations for lower tier covered transactions related to this Agreement.
24. E-VERIFICATION OF EMPLOYEES
The County warrants that it is in compliance with A.R.S. § 41-4401 and further
acknowledges:
A. That the County and its subcontractors, if any, warrant their compliance with all
federal immigration laws and regulations that relate to their employees and their
compliance with A.R.S. § 23-214;
B. That a breach of the warranty under subsection A above shall be deemed a
material breach of this Agreement that entitles the School District to, among
other things, immediately terminate this Agreement without liability;
C. That the School District retains the legal right to inspect the papers of any County
or subcontractor employee who works pursuant to this Agreement to ensure that
the County or subcontractor is complying with the warranty provided under
subsection A above and that the County agrees to make all papers and
employment records of said employee(s) available during normal working hours
in order to facilitate such an inspection;
D. That nothing herein shall make any County or subcontractor an agent or
employee of the school district.
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SECTION II SPECIAL PROVISIONS
1. EFFECT
To the extent that the Special Provisions are in conflict with the General Provisions, the
Special Provisions shall control. To the extent that the Work Statement(s) are in conflict
with the Special or General Provisions, the Work Statement(s) shall control.
2. DISPUTES
Except as otherwise provided by law, or otherwise specifically agreed to by the Parties,
any dispute not involving a question of law arising out of this Agreement that is not
resolved between the Parties within a reasonable time, which shall not exceed 120 days,
shall be resolved as follows:
A. Disputes must be filed with the person administering this Agreement for the
County, if one has been appointed, or, if not, with the Department, within ten (10)
days from the date the Parties knew or should have known the basis of the
dispute.
B. The person administering this Agreement or the Department, as applicable, shall
respond in writing to the dispute within fourteen (14) days.
C. The Parties may abide by the decision or may choose to resolve the dispute as
set forth in the Mediation/Arbitration Clause of the Special Provisions of this
Agreement.
This Paragraph shall not apply to claims arising from bodily injury, death, or property
damage.
3. MEDIATION/ARBITRATION
In the event that any dispute arises out of this Agreement or involves a recipient of
services under the terms of this Agreement, the Parties shall meet and confer in an effort
to resolve the dispute. In the event that such efforts to resolve the dispute are
unsuccessful, the Parties shall resolve the dispute by arbitration pursuant to A.R.S. § 12-
1518(A).
4. CHANGES
A. The Department may, at any time, by written order, make changes within the
scope of this Agreement in any one or more of the following areas:
1). Work Statement activities reflecting changes in the scope of services,
funding source, or County regulations, policies, or requirements.
2). Administrative requirements, such as changes in reporting periods,
frequency of reports, or report formats required by funding source, or
County regulations, policies, or requirements.
3). County schedules and program budgets
B. The Department shall not direct substantive changes in services to be rendered
by the County.
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SECTION II SPECIAL PROVISIONS
C. Any dispute or disagreement caused by such written order shall constitute a
"Dispute" within the meaning of the Disputes Clause of the Special Provisions of
this Agreement and shall be administered accordingly.
5. UNIFORM ADMINISTRATIVE REQUIREMENTS
By entering into this Agreement the County agrees to comply with all applicable
provisions of Title 2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE
REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL
AWARDS contained in Title 2 C.F.R. § 200 et seq.
6. LAWS, RULES AND REGULATIONS
The School District and the County understand and agree that this Agreement is subject
to all State and federal laws, rules, and regulations that pertain hereto.
A. Neither this Agreement, nor any portion thereof, may be assigned to another
person by the School District without the written consent of the County’s
designated representative. Any attempt by the School District to assign any
portion of this Agreement without the written consent of the County shall
constitute a breach of this Agreement.
B. No assignment shall alter the School District’s responsibility to the County to
assure that all of the provisions under this Agreement are carried out by its
assignee. All terms and conditions in this Agreement shall be included in the
School District’s assignments.
7. SPECIAL REQUIREMENTS
A. If the use of subcontractors is approved by School District, the County shall use
written subcontracts or consultant agreements that conform to Federal and State
laws and regulations, and to the requirements of this Agreement appropriate to
the service or activity covered by the subcontract. These provisions apply with
equal force to the subcontract as if the subcontractor were the County referenced
herein. The County is responsible for performing under this Agreement whether
or not subcontracts are used. The County shall submit a copy of each
subcontract to the School District within fifteen (15) days of its effective date.
B. The County shall include in any subcontracts a provision to the effect that the
subcontractor agrees that the School District shall have access to the
subcontractor’s facilities and the right to examine any books, documents, and
records of the subcontract, involving transactions related to the subcontract and
that such books, documents, and records shall not be disposed of except as
provided herein.
8. STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST
Notice is given that pursuant to A.R.S. § 38-511, the County may cancel this Agreement
without penalty or further obligation within three years after execution of this Agreement,
if any person significantly involved in initiating, negotiating, securing, drafting, or creating
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SECTION II SPECIAL PROVISIONS
this Agreement on behalf of the County is at any time while this Agreement or any
extension of this Agreement is in effect, an employee or agent of any other Party to this
Agreement in any capacity or consultant to any other Party of this Agreement with
respect to the subject matter of this Agreement. Additionally, pursuant to A.R.S. § 38-
511, the County may recoup any fee or commission paid or due to any person
significantly involved in initiating, negotiating, securing, drafting, or creating this
Agreement on behalf of the County from any other Party to this Agreement arising as the
result of this Agreement.
This Agreement may be cancelled pursuant to A.R.S. § 38-511.
9. POLICY ON CONFIDENTIALITY
The School District and the County understand and agree that this Agreement is subject
to all State and federal laws protecting client confidentiality of medical, behavioral health
and drug treatment information.
10. SPONSORSHIP ACKNOWLEDGMENT
All promotional materials, brochures, and flyers prepared by the County shall include the
following statement, “Sponsored by MCDPH.”
11. ISRAEL BOYCOTT
By submitting this Agreement the County certifies that they are in compliance with Article
9, A.R.S. Section 35-393 et seq.
12. WORKERS’ COMPENSATION
An employee of either party shall be deemed to be an “employee” of both public
agencies while performing pursuant to this Agreement solely for the purposes of A.R.S.
§ 23-1022 and the Arizona Workers’ Compensation laws. The primary employer shall
be solely liable for any workers’ compensation benefits which may accrue.
Each party shall post a notice pursuant to the provisions of A.R.S. § 23-1022 in
substantially the following form:
“All employees are hereby further notified that they may be required to work under
jurisdiction or control of or within the jurisdictional boundaries of another public agency
pursuant to an intergovernmental agreement or contract, and under such circumstances
they are deemed by the laws of Arizona, to be employees of both public agencies for the
purposes of workers’ compensation.”
13. FINGERPRINT AND CERTIFICATION REQUIREMENTS/JUVENILE SERVICES
The Fingerprint and Certification Requirements listed in this section apply to this
Agreement to the extent it pertains to services to juveniles.
A. The County shall require that all paid and unpaid personnel who are required or
are allowed to provide services directly to juveniles have met all fingerprint and
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SECTION II SPECIAL PROVISIONS
certification requirements of A.R.S. §§ 15-512, 36-882 and 36-425.03 and the
School District prior to providing such services.
B. The County shall submit verification of fingerprinting and certification of an
employee by the Department of Economic Security, the Department of
Corrections or the Arizona Supreme Court to meet this requirement.
C. The County shall require and verify that those employees who qualify only for a
restricted certification shall be supervised when providing services directly to
juveniles.
D. The County shall require that all subcontracts for services to juveniles include a
provision requiring compliance by the subcontractors with A.R.S. §§36-882 and
36-425.03.
E. This Agreement may be canceled if the fingerprint certifications or the
Certification for Employment required by A.R.S. § 36-425.03 of any employee,
including volunteers (whether or not paid) shows that he or she has committed,
been convicted of, or is awaiting trial for any offense(s) listed on the Certification
for Employment form in this state or similar offenses in another state or
jurisdiction.
14. COMMUNICATION
The County shall assume primary responsibility for effective, efficient communication
with Office of Oral Health Representative.
15. IT IS MUTUALLY UNDERSTOOD AND AGREED BY AND BETWEEN THE PARTIES
THAT:
A. This instrument is neither a fiscal nor a funds obligation document. Any
endeavor or transfer of anything of value involving reimbursement or contribution
of funds between the parties to this instrument will be handled in accordance with
applicable laws, regulations, and procedures including those for Government
procurement and printing. Such endeavors will be outlined in separate
agreements that shall be made in writing by representatives of the parties and
shall be independently authorized by appropriate statutory authority. This
instrument does not provide such authority. Specifically, this instrument does not
establish authority for noncompetitive award to the cooperator of any contract or
other agreement
B. PARTICIPATION IN SIMILAR ACTIVITIES
This agreement in no way restricts MCDPH or WESD from participating in similar
activities with other public or private agencies, organizations, and individuals.
16. NOTICE:
Any notice given under this Agreement shall be sent to the attention of the following:
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SECTION II SPECIAL PROVISIONS
Maricopa County Department of Public Health
Dalila Guerrero
Office of Oral Health
1645 East Roosevelt
Phoenix, Arizona 85006
Phone No.: (602) 506-6946
Email: dalilaguerrero@mail.maricopa.gov
Maricopa County Department of Public Health, Grants
and Contracts Unit
Grants and Contracts Administrator
4041 N. Central Avenue, Suite 1400
Phoenix, Arizona 85012
Washington Elementary School District
Cathy Thompson
Director of Business Services
4650 W. Sweetwater
Glendale, AZ 85304
Cathy.thompson@wesdschools.org
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SECTION III WORK STATEMENT
Background
Tooth decay is the most prevalent chronic disease currently affecting children, accounting for
approximately 51 million school hours lost each year in the United States. Tooth decay and
resultant pain can have an adverse effect on overall health, good nutrition, self-esteem, and
ability to learn. Among the 43 states that collect data in the same way, Arizona ranks #3 in
highest percentage (over 40%) of third grade children with untreated tooth decay. Conversely,
the state of Washington has the lowest percentage of children with untreated tooth decay (less
than 15%) among the Western states.
Dental sealants are a proven best-practice for reducing tooth decay in the chewing surfaces of
permanent molars. These teeth are best protected if dental sealants are applied soon after
these molars erupt (second and sixth grades). Dental sealants can protect these molar chewing
surfaces from decay for many years. The procedure takes about 15 minutes per child, is pain
free, and requires no “shots” or drilling.
School-based dental sealant programs are evidence-based and provide a safe, inexpensive
model for delivering sealants to school-age children, with less learning time lost. The Maricopa
County Department of Public Health (MCDPH), Office of Oral Health (MCOOH) requests that
Washington Elementary School District join MCOOH in partnership to prevent tooth decay and
improve the health of their second and sixth grade students during the 2017-2018 school year.
This Intergovernmental Agreement (IGA) will bring dental screenings and sealants to eligible
schools in the Washington Elementary School District (WESD). A licensed dentist will provide
written take-home findings and a list of dental clinics to all (insured and uninsured) second and
sixth grade students who return “positive” parental consent forms. The program will then
provide dental sealants to any of these same students who are clinically eligible and uninsured,
or currently enrolled in AHCCCS or KidsCare. These preventive services are provided at no
cost to the school or the child.
1. PURPOSE
The purpose of this IGA is to develop a framework of cooperation between MCDPH and
WESD to provide dental sealants to eligible students for the prevention of tooth decay.
2. STATEMENT OF MUTUAL BENEFIT AND INTERESTS
The mutual benefit for both parties is the prevention of tooth decay for students without
private dental insurance.
3. MCDPH SHALL:
A. Contact and schedule a dental sealant screening date for eligible WESD Schools
that have submitted a Program application form to MCOOH.
B. Provide program information and parental consent forms, one month in advance
of the scheduled screening date, to the school nurse or designated liaison.
C. Provide technical assistance to the school nurse or designated liaison to ensure
successful implementation of the Program.
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SECTION III WORK STATEMENT
D. Provide licensed dentists and dental hygienists, and trained dental assistants to
conduct the dental screening and dental sealant activities at each school.
E. Check State Board of Dental Examiners licensing records on licensed MCDPH
dental providers; conduct background checks of all dental providers.
F. Supply identification badges for dental providers.
G. Instruct all dental providers to register in the school office upon arrival on
campus.
H. Furnish/bring all necessary dental supplies needed to conduct the dental
screening/sealant activities on WESD premises.
I. Ensure that assigned space for conducting the dental sealant activities is
returned to its original condition.
J. Provide oral health education materials for parents, teachers and school nurse.
K. Provide community dental clinic information to parents, teachers and school
nurse.
L. Provide program evaluation form for school nurse or liaison to submit following
program completion.
M. Provide summary reports to each school, which will include information such as
the number of children screened, the number of eligible children needing and
receiving dental sealants, the number of sealants placed and the dollar value,
and a list of students urgently needing dental treatment.
N. Maintain all student information according to confidentiality requirements.
4. WESD SHALL:
A. Promote participation in the dental sealant program at district schools through
communication with principals, teachers, school office, and health office
personnel.
B. Require school health personnel and teachers of second and sixth grade
students to make distribution and receipt of parental consent forms a priority.
C. Keep returned consent forms separated by class and give them to the dental
team upon arrival.
D. Provide adequate physical space at each school for the dental screening and
sealant treatment services to be delivered because the school-based dental
sealant program promotes the education function of the District. The space at
each school will include at a minimum:
1) A room or area large enough to accommodate the dental team,
equipment, and several children.
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SECTION III WORK STATEMENT
2) A room or area where the equipment may stay overnight if the team
needs to return the following day.
3) One table and large trash receptacle per dental team.
4) Accessible electrical outlets.
E. Provide assistance (if necessary, or if required) with student identification,
release and transport from class on the screening and sealant days
F. Provide outreach to parents/guardians with children having urgent dental needs
so that referrals to dental services occur within 24 hours of the initial dental
screening.
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